Nurse's Pocket Drug Guide 2009

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NURSE’S POCKET DRUG GUIDE 2009

EDITOR Judith A. Barberio, PhD, APN,C, ANP, FNP, GNP

CONSULTING EDITOR Leonard G. Gomella, MD, FACS

ASSOCIATE EDITORS Steven A. Haist, MD, MS, FACP Aimee Gelhot Adams, PharmD Kelly M. Smith, PharmD, FASHP

New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by Judith A. Barberio. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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DOI: 10.1036/0071549706 Professional

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CONTENTS

EDITORS v PREFACE vii MEDICATION KEY ix ABBREVIATIONS xiii CLASSIFICATION 1 Allergy 1 Antidotes 1 Antimicrobial Agents 1 Antifungals 3 Antineoplastic Agents 4 Antiretrovirals 6 Cardiovascular (CV) Agents 6 Central Nervous System Agents 9 Dermatologic Agents 10 Dietary Supplements 11 Ear (OTIC) Agents 12 Endocrine System Agents 12 Eye (Ophthalmic) Agents 13 Gastrointestinal Agents 15 Hematologic Agents 16 Immune System Agents 17 Musculoskeletal Agents 19 OB/GYN Agents 19 Pain Medications 21 Respiratory Agents 22 Urinary/Genitourinary Agents 23 Wound Care 24 Miscellaneous Therapeutic Agents 24 Natural & Herbal Agents 24

iii iv Contents

GENERIC AND SELECTED BRAND DRUG DATA 25 COMMONLY USED MEDICINAL HERBS 296 TABLES 309 INDEX 335 EDITORS

EDITOR Judith A. Barberio, PhD, APN,C, ANP, FNP, GNP Assistant Professor Coordinator, Adult & Family Nurse Practitioner Tracks Rutgers, The State University of New Jersey College of Nursing Newark, New Jersey

CONSULTING EDITOR Leonard G. Gomella, MD, FACS The Bernard W. Godwin, Jr., Professor Chairman, Department of Urology Jefferson Medical College Associate Director of Clinical Affairs Kimmel Cancer Center Thomas Jefferson University Philadelphia, Pennsylvania

ASSOCIATE EDITORS Steven A. Haist, MD, MS, FACP Professor of Medicine Associate Chair for Education and Residency Program Director Department of Internal Medicine University of Kentucky Medical Center Lexington, Kentucky

Aimee Gelhot Adams, PharmD Assistant Professor College of Pharmacy and Department of Internal Medicine Clinical Specialist, Primary Care University of Kentucky Medical Center Lexington, Kentucky

Kelly M. Smith, PharmD, FASHP Associate Professor Department of Pharmacy Practice and Science University of Kentucky College of Pharmacy Clinical Specialist, Medical Use Policy University of Kentucky Medical Center Lexington, Kentucky PREFACE

WE ARE PLEASED TO PRESENT THE FIFTH EDITION OF THE NURSE’S POCKET DRUG GUIDE. Our goal is to identify the most frequently used and clinically important medications, including branded, generic, and OTC products. The book includes over 1000 generic medications and is designed to repre- sent a cross section of commonly used products in health care practices across the country. The style of drug presentation includes key “must know” facts of commonly used medications and herbs, essential information for the student, practicing nurse, and health care provider. The inclusion of common uses of medications rather than just the official FDA-labeled indications are based on the uses of the medication and herbs supported by publications and community standards of care. All uses have been reviewed by our editorial board. It is essential that students, registered nurses, and advanced-practice nurses learn more than the name and dose of the medications they administer and prescribe. Certain common side effects and significant contraindications are associated with most prescription medications. Although nurses and other health care practitioners should ideally be completely familiar with the entire package insert of any medication prescribed, such a requirement is unreasonable. References such as the Physicians’ Desk Reference and the drug manufacturer’s Web site make package inserts readily available for many medications, but may not highlight clinically significant facts or key data for generic drugs and those available over the counter. The limitations of difficult-to-read package inserts were acknowledged by the Food and Drug Administration in early 2001, when it noted that health care providers do not have time to read the many pages of small print in the typical package insert. Newer drugs are producing more user-friendly package insert summaries that will highlight important drug information for easier nursing reference. Although useful, these summaries do not commingle with similarly approved generic or “competing” similar products. The editorial board has analyzed the information on both brand and generic medications and has made this key prescribing information available in this pocket-sized book. Information in this book is meant for use by health care professionals who are familiar with these commonly prescribed medications. This 2009 edition has been completely reviewed and updated by our editorial board. Over 55 new drugs and herbs have been added, and changes in other vii Copyright © 2009 by Judith A. Barberio. Click here for terms of use. viii Preface medications based on FDA actions have been incorporated, including deletions of discontinued brand names and compounds. New to this edition are the therapeutic and pharmacologic classifications for each drug and a section on commonly used vitamin combinations. Where appropriate, emergency cardiac care (ECC) guidelines are provided based on the latest recommendations for the American Heart Association (Circula- tion, Volume 112, Issue 24 Supplement; December 13, 2005). We express special thanks to our families for their long-term support of this book. The contributions of the members of the editorial board are deeply appreci- ated. The assistance of Quincy McDonald, and the team at McGraw-Hill are also to be thanked for their support in our goal of creating a pocket drug guide for nursing professionals. Your comments and suggestions are always welcome and encouraged because improvements to this book would be impossible without the interest and feedback of our readers. We hope this book will help you learn some of the key elements in prescribing medications and allow you to care for your patients in the best way possible.

Judith A. Barberio, PhD, APN,C, ANP, FNP, GNP Newark, New Jersey [email protected]

Leonard G. Gomella, MD, FACS Philadelphia, Pennsylvania [email protected] MEDICATION KEY

Medications are listed by prescribing class, and the individual medications are then listed in alphabetical order by generic name. Some of the more commonly recognized trade names are listed for each medication (in parentheses after the generic name) or if available without prescription, noted as OTC (over the counter).

Generic Drug Name (Selected Common Brand Names [Controlled Substance]) WARNING: Summarized version of the “Black Box” precautions deemed necessary by the FDA. These are significant precautions and contraindications concerning the individual medication. Therapeutic and/or Pharmacologic Class: Class is pre- sented in brackets immediately following the brand name drug. The therapeutic drug class appears first and describes the disease state that the drug treats. The pharmacologic drug class follows and is based on the drug’s mechanism of action. Uses: This includes both FDA labeled indications bracketed by * and other “off label” uses of the medication. Be- cause many medications are used to treat various conditions based on the medical literature and not listed in their package insert, we list common uses of the medication rather than the official “labeled indications” (FDA approved) based on input from our editorial board Action: How the drug works. This information is helpful in comparing classes of drugs and understanding side effects and contraindications. Spectrum: Specifies activity against selected microbes Dose: Adults. Where no specific pediatric dose is given, the implication is that this drug is not commonly used or indicated in that age group. At the end of the dosing line, important dosing modifications may be noted (ie, take with food, avoid antacids, etc) Caution: [pregnancy/fetal risk categories, breast-feeding (as noted above)] cautions concerning the use of the drug in specific settings Contra: Contraindications Disp: Common dosing forms SE: Common or significant side effects Notes: Other key information about the drug Interac- tions: Common drug—drug, drug—herb, and drug—food interactions that may change the drug response Labs: Common laboratory test results that are changed by the drug or significant lab monitoring requirements NIPE: (Nursing Indications and/or Patient Education) Significant information that the nurse must be aware of with administration of the drug or information that should be given to any patient taking the drug.

CONTROLLED SUBSTANCE CLASSIFICATION Medications under the control of the US Drug Enforcement Agency (Schedule I–V controlled substances) are indicated by the symbol [C]. Most medications are “uncontrolled” and do not require a DEA prescriber number on the prescription. The following is a general description for the schedules of DEA controlled substances:

Schedule (C–I) I: All nonresearch use forbidden (eg, heroin, LSD, mescaline, etc).

Schedule (C–II) II: High addictive potential; medical use accepted. No tele- phone call-in prescriptions; no refills. Some states require special prescription form (eg, cocaine, morphine, methadone).

Schedule (C–III) III: Low to moderate risk of physical dependence, high risk of psychologic dependence; prescription must be rewritten after 6 months or five refills (eg, acetaminophen plus codeine).

Schedule (C–IV) IV: Limited potential for dependence; prescription rules same as for schedule III (eg, benzodiazepines, propoxyphene).

Schedule (C–V) V: Very limited abuse potential; prescribing regulations often same as for uncontrolled medications; some states have additional restrictions.

FDA FETAL RISK CATEGORIES

Category A: Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy; there is no evidence of risk in the last two trimesters.

Category B: Animal studies have not demonstrated a risk to the fetus, but no adequate studies have been done in pregnant women. or Animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy and there is no evidence of risk in the last two trimesters.

Category C: Animal studies have shown an adverse effect on the fetus, but no adequate studies have been done in humans. The benefits from the use of the drug in pregnant women may be acceptable despite its potential risks. or No animal reproduction studies and no adequate studies in humans have been done.

Category D: There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks. Medication Key xi

Category X: Studies in animals or humans or adverse reaction reports, or both, have demonstrated fetal abnormalities. The risk of use in pregnant women clearly outweighs any possible benefit.

Category ?: No data available (not a formal FDA classification; included to provide complete data set).

BREAST-FEEDING No formally recognized classification exists for drugs and breast-feeding. This shorthand was developed for the Nurse’s Pocket Drug Guide.

+ Compatible with breast-feeding M Monitor patient or use with caution ± Excreted, or likely excreted, with unknown effects or at unknown concentrations ?/– Unknown excretion, but effects likely to be of concern – Contraindicated in breast-feeding ? No data available This page intentionally left blank ABBREVIATIONS

v: check or monitor AUC: area under the curve Ab: Antibody AV: atrioventricular ABMT: autologous bone marrow AVM: arteriovenous malformation transplantation BCL: B-cell lymphoma Ac: before meals BM: bone marrow; bowel movement ACE: angiotensin-converting enzyme ↓ BM: hypotension ACEI: angiotensin-converting ↓BM: bone marrow suppression, enzyme inhibitor myelosuppression ACLS: advanced cardiac life support BMT: bone marrow transplantation ACS: acute coronary syndrome, BOO: bladder outlet obstruction American Cancer Society, BP: blood pressure American College of Surgeons BSA: body surface area ADH: antidiuretic hormone BUN: blood urea nitrogen ADHD: attention-deficit Ca: calcium hyperactivity disorder CA: cancer ADR: adverse drug reaction CAD: coronary artery disease AF: atrial fibrillation CAP: community acquired Al: aluminum pneumonia ALL: acute lymphocytic leukemia CBC: complete blood count ALT: alanine aminotransferase CCB: calcium channel blocker AMI: acute myocardial infarction CF: cystic fibrosis AML: acute myelogenous leukemia CHF: congestive heart failure Amp: ampule CLA: Cis-linoleic acid ANC: absolute neutrophil count CLL: chronic lymphocytic leukemia APAP: acetaminophen: [N-acetyl-p- CML: chronic myelogenous leukemia aminophenol] CMV: cytomegalovirus aPTT: activated partial CNS: central nervous system thromboplastin time COMT: catechol-O-methyltransferase ARB: angiotensin II receptor blocker Contra: contraindicated ARDS: adult respiratory distress COPD: chronic obstructive syndrome pulmonary disease ASA: asprin (acetylsalicylic acid) CP: chest pain

CPK: creatine phosphokinase ELISA: enzyme-linked CPP: central precocious puberty immunosorbent assay CR: controlled release EMIT: enzyme-multiplied CrCl: creatinine clearance immunoassay text CRF: chronic renal failure EPS: extrapyramidal symptoms CV: cardiovascular (tardive dyskinesia, tremors and CVA: cerebrovascular accident, rigidity, restlessness [akathisia], costovertebral angle muscle contractions [dystonia], CVH: common variable changes in breathing and heart hypergammaglobulinemia rate) D: diarrhea ER: extended release D5LR: 5% dextrose in lactated ESRD: end-stage renal disease Ringer’s solution ET: endotracheal D5NS: 5% dextrose in normal saline EtOH: ethanol D5W: 5% dextrose in water FSH: follicle-stimulating hormone D/C: discontinue 5-FU: fluorouracil DI: diabetes insipidus Fxn: function Disp: dispensed as, how the drug is g: gram supplied GABA: gama-aminobutyric acid DKA: diabetic ketoacidosis G-CSF: granulocyte colony- dL: deciliter stimulating factor DM: diabetes mellitus gen: generation DMARD: Disease-modyfying GERD: gastroesophageal reflux antirheumatic drug; drugs defined disease in randomized trials to decrease GF: growth factor erosions and joint space narrowing GFR: glomerular filtration rate in rheumatoid arthritis (eg, GH: growth hormone D-penicillamine, methotrexate, GI: gastrointestinal azathioprine) GIST: Gastrointestinal stromal tumor DN: diabetic nephropathy GLA: Gamma-linoleic Acid dppr: dropper GM-CSF: granulocyte-macrophage DOT: directly observed therapy colony-stimulating factor d/t: due to GnRH: gonadotropin-releasing DVT: deep venous thrombosis hormone Dz: disease gt, gtt: drop, drops (gutta) EC: enteric-coated GTT: Glucose Tolerance Test ECC: emergency cardiac care GUHD: Graft URS Host Disease ECG: electrocardiogram HA: headache ED: erectile dysfunction HCG: human chorionic gonadotropin EGFR: epidermal growth factor HCL: hairy cell leukemia receptor Hct: hematocrit Abbreviations xv

HCTZ: hydrochlorothiazide K/K+: potassium HD: hemodialysis LA: long acting HF: heart failure L/d: liters per day Hgb: hemoglobin LDL: low-density lipoprotein HIT: heparin-induced LFT: liver function test thrombocytopenia LH: luteinizing hormone HIV: human immunodeficiency virus LHRH: luteinizing hormone- HMG-CoA: hydroxymethylglutaryl releasing hormone coenzyme A Li: lithium h/o: history of Liq: liquid HR: heart rate LMW: low molecular weight ↑ HR: increased heart rate LVD: left ventricular dysfunction (tachycardia) LVEF: left ventricular ejection hs: at bedtime (hora somni) fraction HSV: herpes simplex virus LVSD: left ventricular systolic 5-HT: 5-hydroxytryptamine dysfunction HTN: hypertension MAC: Mycobacterium avium Hx: History of complex I: Iodine MAO/MAOI: monoamine IBD: irritable bowel disease oxidase/inhibitor IBS: irritable bowel syndrome MDI: multidose inhaler ICP: intracranial pressure mEq: milliequivalent IFIS: Intraoperative Floppy Iris Mg/Mg+2: magnesium Syndrome MI: myocardial infarction, mitral Ig: immunoglobulin insufficiency IM: intramuscular mL: milliliter Inf: infusion MoAb: monoclonal antibody Infxn: infection MRSA: methicillin-resistant Inh: inhalation Staphylococcus aureus INH: isoniazid MS: multiple sclerosis INR: international normalized ratio MSSA: methicillin-sensitive Insuff: insufficiency Staphylococcus aureus Intravag: intravaginal MTT: monotetrazolium I&O: intake & output MTX: methotrexate IOP: intraocular pressure MyG: myasthenia gravis ISA: intrinsic sympathomimetic N: nausea activity na: sodium IT: intrathecal NA: narrow angle ITP: idiopathic thrombocytopenic NAG: narrow angle glaucoma purpura ng: nanogram IV: intravenous NG: nasogastric xvi Abbreviations

NHL: non-Hodgkin’s lymphoma ↓ plt; decreased platelets NIDDM: non-insulin-dependent (thrombocytopenia) diabetes mellitus PMDD: premenstrual dysphoric nl: normal disorder NMDA: N-Methyl-D-Aspartate PO: by mouth (per os) NNRTI: nonnucleoside reverse PPD: purified protein derivative transcriptase inhibitor PR: by rectum NO: nitric oxide Prep: preparation NPO: nothing by mouth (nil per os) PRG: pregnancy NRTI: nucleoside reverse PRN: as often as needed (pro re nata) transcriptase inhibitor PSVT: paroxysmal supraventricular NS: normal saline tachycardia NSAID: nonsteroidal anti- pt: patient inflammatory drug PT: prothrombin time NSCLC: non-small-cell lung cancer PTCA: percutaneous transluminal N/V: nausea and vomiting coronary angioplasty N/V/D: nausea, vomiting, diarrhea PTH: parathyroid hormone OAB: overactive bladder PTT: partial thromboplastin time OCP: oral contraceptive pill PUD: peptic ulcer disease OD: overdose PVC: premature ventricular ODT: orally disintegrating tablets contraction OK: recommended PVD: peripheral vascular disease OTC: over the counter PWP: pulmonary wedge pressure P: phosphorus Px: prevention PABA: para-amino benzoic acid q: every (quaque) PAT: paroxysmal atrial tachycardia qd: every day pc: after eating (post cibum) qh: every hour PCa: cancer of the prostate q_h: every _ hours PCN: penicillin qhs: every hour of sleep (before PCP: Pneumocystis jiroveci (formerly bedtime) carinii) pneumonia qid: four times a day (quater in die) PCWP: pulmonary capillary wedge qod: every other day pressure RA: rheumatoid arthritis PDE5: phosphodiesterase type 5 RCC: renal cell carcinoma PDGF: platelet-derived growth RDA: recommended dietary factor allowance PE: pulmonary embolus, physical RDS: respiratory distress syndrome examination, pleural effusion resp: respiratory PFT: pulmonary function test RSV: respiratory syncytial virus pg: picogram RT: reverse transcriptase PID: pelvic inflammatory disease RTA: renal tubular acidosis plt: platelet Rx: prescription or therapy Abbreviations xvii

Rxn: reaction TNF: tumor necrosis factor SCr: serum creatinine tox: toxicity SDV: Single Dose Vial TPA: tissue plasminogen activator SIADH: syndrome of inappropriate tri: trimester antidiuretic hormone TSH thyroid stimulating hormone SL: sublingual Tsp: teaspoon SLE: systemic lupus erythematosus TTP: thrombotic thrombocytopenic Sol/soln: solution purpura Sp: species TTS: transdermal therapeutic system SPAG: small particle aerosol Tx: treatment generator uln: upper limits of normal SNRIs: serotonin-norepinephrine UPA: pyrrolizidine alkaloids reuptake inhibitors URI: upper respiratory infection SQ: subcutaneous UTI: urinary tract infection SR: sustained release Vag: vaginal SSRI: selective serotonin reuptake VF: ventricular fibrillation inhibitor VRE: vancomycin-resistant SSS: sick sinus syndrome Enterococcus S/Sys: signs & symptoms VT: ventricular tachycardia stat: immediately (statim) W/: with supl: supplement WHI: Women’s Health Initiative supp: suppository W/in: within SVT: supraventricular tachycardia Wk: week Sx: symptom WNL: within normal limits Sz: seizure w/o: without tab/tabs: tablet/tablets WPW: Wolff–Parkinson–White TB: tuberculosis syndrome TCA: tricyclic antidepressant Wt: weight TFT: thyroid function test XR: extended release TIA: transient ischemic attack ZE: Zollinger–Ellison (syndrome) tid: three times a day (ter in die) >: greater than; older than tinc: tincture ↑: increase TMP: trimethoprim ↓: decrease TMP–SMX: ∅: not recommended; do not take trimethoprim–sulfamethoxazole ÷/%: divided dose This page intentionally left blank CLASSIFICATION (Generic and common brand names)

ALLERGY Antihistamines Azelastine (Astelin, Clemastine Fumarate Fexofenadine (Allegra) Optivar) (Tavist) Hydroxyzine (Atarax, Cetirizine (Zyrtec, Cyproheptadine Vistaril) Zyrtec D) (Periactin) Loratadine (Claritin, Chlorpheniramine Desloratadine (Clarinex) Alavert) (Chlor-Trimeton) Diphenhydramine (Benadryl)

Miscellaneous Antiallergy Agents Budesonide (Rhinocort, Cromolyn Sodium (Intal, Montelukast (Singulair) Pulmicort) NasalCrom, Opticrom)

ANTIDOTES Acetylcysteine (Aceta- Dexrazoxane (Zinecard) Mesna (Mesnex) dote, Mucomyst) Digoxin Immune Fab Naloxone (Narcan, Activated Charcoal (Digibind, DigiFab) Nalone, Narcanti) (SuperChar, Actidose, Flumazenil (Romazicon) Physostigmine Liqui-Char) Hydroxocobalamin (Antilirium) Amifostine (Ethyol) (Cyanokit) Succimer (Chemet) Atropine (AtroPen) Ipecac Syrup, an over-the- Deferasirox (Exjade) counter (OTC) syrup

ANTIMICROBIAL AGENTS Antibiotics AMINOGLYCOSIDES Amikacin (Amikin) Neomycin Tobramycin (Nebcin) Gentamicin (Garamycin, Streptomycin G-Mycitin)

CARBAPENEMS Ertapenem (Invanz) Imipenem-Cilastatin Meropenem (Merrem) (Primaxin)

CEPHALOSPORINS, FIRST GENERATION Cefadroxil (Duricef, Cephalexin (Keflex) Cephradine (Velosef) Ultracef) Cefazolin (Ancef, Kefzol)

CEPHALOSPORINS, SECOND GENERATION Cefaclor (Ceclor) Cefprozil (Cefzil) Loracarbef (Lorabid) Cefonicid (Monocid) Cefuroxime (Ceftin Cefotetan (Cefotan) [oral], Zinacef Cefoxitin (Mefoxin) [parenteral])

CEPHALOSPORINS, THIRD GENERATION Cefdinir (Omnicef) Cefpodoxime (Vantin) Ceftibuten (Cedax) Cefditoren (Spectracef) Ceftazidime (Fortaz, Ceftizoxime (Cefizox) Cefixime (Suprax) Tazicef) Ceftriaxone (Rocephin) Cefoperazone (Cefobid) Cefotaxime (Claforan)

CEPHALOSPORINS, FOURTH GENERATION Cefepime (Maxipime)

FLUOROQUINOLONES Ciprofloxacin (Cipro) Lomefloxacin Norfloxacin Ophthalmic Gemifloxacin (Factive) (Maxaquin) (Noroxin, Chibroxin) Levofloxacin (Levaquin, Moxifloxacin Ofloxacin Ophthalmic Quixin Ophthalmic) (Avelox) (Floxin, Ocuflox)

KETOLIDE Telithromycin (Ketek)

MACROLIDES Azithromycin Dirithromycin (Dynabac) Erythromycin & (Zithromax) Erythromycin (E-Mycin, Sulfisoxazole (Eryzole, Clarithromycin E.E.S., Ery-Tab) Pediazole) (Biaxin) Classification 3

PENICILLINS Amoxicillin (Amoxil, Nafcillin (Nallpen) Penicillin V (Pen-Vee K, Polymox) Oxacillin (Bactocill, Veetids) Amoxicillin & Clavulanic Prostaphlin) Piperacillin (Pipracil) Acid (Augmentin) Penicillin G, Aqueous Piperacillin-Tazobactam Ampicillin (Amcill, (Potassium or Sodium) (Zosyn) Omnipen) (Pfizerpen, Pentids) Ticarcillin (Ticar) Ampicillin-Sulbactam Penicillin G Benzathine Ticarcillin/Potassium (Unasyn) (Bicillin) Clavulanate (Timentin) Dicloxacillin (Dynapen, Penicillin G Procaine Dycill) (Wycillin)

TETRACYCLINES Doxycycline (Adoxa, Tetracycline Tigecycline (Tygacil) Periostat, Oracea, (Achromycin V, Vibramycin, Sumycin) Vibra-Tabs)

Miscellaneous Antibiotic Agents Aztreonam Metronidazole (Flagyl, Trimethoprim (Azactam) MetroGel) Sulfamethoxazole Clindamycin (Cleocin, Quinupristin-Dalfopristin [Cotrimoxazole] Cleocin-T) (Synercid) (Bactrim, Septra) Fosfomycin Rifaximin (Xifaxan) Vancomycin (Vancocin, (Monurol) Trimethoprim Vancoled) Linezolid (Zyvox)

ANTIFUNGALS Amphotericin B Anidulafungin (Eraxis) Ketoconazole (Nizoral) (Fungizone) Caspofungin (Cancidas) Miconazole (Monistat) Amphotericin B Clotrimazole (Lotrimin, Nystatin (Mycostatin) Cholesteryl Mycelex) Oxiconazole (Oxistat) (Amphotec) Clotrimazole & Posaconazole (Noxafil) Amphotericin B Lipid Betamethasone Sertaconazole (Ertaczo) Complex (Abelcet) (Lotrisone) Terbinafine (Lamisil) Amphotericin B Econazole (Spectazole) Triamcinolone & Nystatin Liposomal Fluconazole (Diflucan) (Mycolog-II) (AmBisome) Itraconazole (Sporanox) Voriconazole (VFEND) 4 Nurse’s Pocket Drug Guide 2009

Antimycobacterials Dapsone, Oral Pyrazinamide Rifapentine (Priftin) Ethambutol (Myambutol) Rifabutin (Mycobutin) Streptomycin Isoniazid (INH) Rifampin (Rifadin)

Antiprotozoals Nitazoxanide (Alinia) Tinidazole (Tindamax)

ANTINEOPLASTIC AGENTS Alkylating Agents Altretamine (Hexalen) Carboplatin (Paraplatin) Procarbazine (Matulane) Busulfan (Myleran, Cisplatin (Platinol) Triethylenethiophospho- Busulfex) Oxaliplatin (Eloxatin) ramide (Thiotepa)

NITROGEN MUSTARDS Chlorambucil Ifosfamide (Ifex, Melphalan [L-PAM] (Leukeran) Holoxan) (Alkeran) Cyclophosphamide Mechlorethamine (Cytoxan, Neosar) (Mustargen)

NITROSOUREAS Carmustine [BCNU] Streptozocin (Zanosar) (BiCNU, Gliadel)

Antibiotics Bleomycin Sulfate Daunorubicin (Dauno- Epirubicin (Ellence) (Blenoxane) mycin, Cerubidine) Idarubicin (Idamycin) Dactinomycin Doxorubicin Mitomycin (Mutamycin) (Cosmegen) (Adriamycin, Rubex)

Antimetabolites Clofarabine (Clolar) Fludarabine Phosphate Methotrexate Cytarabine [ARA-C] (Flamp, Fludara) (Rheumatrex) (Cytosar-U) Fluorouracil [5-FU] Nelarabine (Arranon) Cytarabine Liposome (Adrucil) Pemetrexed (Alimta) (DepoCyt) Gemcitabine (Gemzar) 6-Thioguanine [6-TG] Floxuridine Mercaptopurine [6-MP] (FUDR) (Purinethol) Classification 5

Hormones Anastrozole (Arimidex) Fulvestrant (Faslodex) Megestrol Acetate Bicalutamide (Casodex) Goserelin (Zoladex) (Megace) Estramustine Phosphate Leuprolide (Lupron, Nilutamide (Nilandron) (Estracyt, Emcyt) Viadur, Eligard) Tamoxifen Exemestane Levamisole Triptorelin (Trelstar (Aromasin) (Ergamisol) Depot, Trelstar LA) Fluoxymesterone (Halotestin, Androxy) Flutamide (Eulexin)

Mitotic Inhibitors Etoposide [VP-16] Vincristine (Oncovin, Vinorelbine (Navelbine) (VePesid) Vincasar PFS) Vinblastine (Velban, Velbe)

Monoclonal Antibodies Cetuximab (Erbitux) Panitumumab (Vectibix) Trastuzumab (Herceptin) Erlotinib (Tarceva)

Miscellaneous Antineoplastic Agents Aldesleukin [Interleukin- Gefitinib (Iressa) Pemetrexed (Alimta) 2, IL-2] (Proleukin) Gemtuzumab Ozogamicin Rasburicase (Elitek) Aminoglutethimide (Mylotarg) Sorafenib (Nexavar) (Cytadren) Hydroxyurea (Hydrea, Sunitinib (Sutent) L-Asparaginase (Elspar, Droxia) Temsirolimus (Torisel Oncaspar) Imatinib (Gleevec) Kit) BCG [Bacillus Calmette- Irinotecan (Camptosar) Thalidomide (Thalomid) Guérin] (TheraCys, Letrozole (Femara) Topotecan (Hycamtin) Tice BCG) Leucovorin (Wellcovorin) Tretinoin, Topical Bevacizumab (Avastin) Mitoxantrone [Retinoic Acid] Bortezomib (Velcade) (Novantrone) (Retin-A, Avita, Cladribine (Leustatin) Paclitaxel (Taxol, Renova, Retin-A Dacarbazine (DTIC) Abraxane) Micro) Docetaxel (Taxotere) Panitumumab (Vectibix) 6 Nurse’s Pocket Drug Guide 2009

ANTIRETROVIRALS Abacavir (Ziagen) Lamivudine (Epivir, Telbivudine (Tyzeka) Amprenavir (Agenerase) Epivir-HBV) Tenofovir (Viread) Delavirdine (Rescriptor) Lopinavir/Ritonavir Tenofovir/Emtricitabine Didanosine [ddI] (Videx) (Kaletra) (Truvada) Efavirenz (Sustiva) Nelfinavir (Viracept) Tipranavir (Aptivus) Efavirenz/Emtricitabine/ Nevirapine (Viramune) Zidovudine (Retrovir) Tenofovir (Atripla) Ritonavir (Norvir) Zidovudine & Lamivudine Fosamprenavir (Lexiva) Saquinavir (Fortovase) (Combivir) Indinavir (Crixivan) Stavudine (Zerit)

Antivirals Acyclovir (Zovirax) Foscarnet (Foscavir) Peginterferon Alfa 2b Adefovir (Hepsera) Ganciclovir (Cytovene, (PEG-Intron) Amantadine Vitrasert) Penciclovir (Denavir) (Symmetrel) Interferon Alfa-2b & Ribavirin (Virazole) Atazanavir (Reyataz) Ribavirin Combo Rimantadine (Flumadine) Cidofovir (Vistide) (Rebetron) Telbivudine (Tyzeka) Emtricitabine Oseltamivir (Tamiflu) Valacyclovir (Valtrex) (Emtriva) Palivizumab (Synagis) Valganciclovir (Valcyte) Enfuvirtide (Fuzeon) Peginterferon Alfa-2a Zanamivir (Relenza) Famciclovir (Famvir) (Pegasys)

Miscellaneous Antiviral Agents Atovaquone (Mepron) Daptomycin (Cubicin) Retapamulin (Altabax) Atovaquone/Proguanil Pentamidine (Pentam Trimetrexate (Neutrexin) (Malarone) 300, NebuPent)

CARDIOVASCULAR (CV) AGENTS ALDOSTERONE ANTAGONIST Eplerenone (Inspra)

Alpha1-Adrenergic Blocker Doxazosin (Cardura) Prazosin (Minipress) Terazosin (Hytrin)

Angiotensin-Converting Enzyme (ACE) Inhibitors Benazepril (Lotensin) Lisinopril (Prinivil, Zestril) Quinapril (Accupril) Captopril (Capoten) Moexipril (Univasc) Ramipril (Altace) Enalapril (Vasotec) Perindopril Erbumine Trandolapril (Mavik) Fosinopril (Monopril) (Aceon) Classification 7

Angiotensin II Receptor Antagonists Candesartan (Atacand) Irbesartan (Avapro) Telmisartan (Micardis) Eprosartan (Teveten) Losartan (Cozaar) Valsartan (Diovan)

Antiarrhythmic Agents Adenosine (Adenocard) Dofetilide (Tikosyn) Procainamide (Pronestyl, Amiodarone (Cordarone, Esmolol (Brevibloc) Pronestyl SR, Pacerone) Flecainide Procanbid) Atropine (Tambocor) Propafenone (Rythmol) Digoxin (Digitek, Ibutilide (Corvert) Quinidine (Quinidex, Lanoxin, Lanoxicaps) Lidocaine (Anestacon Quinaglute) Disopyramide Topical, Xylocaine) Sotalol (Betapace, (NAPamide, Norpace, Mexiletine (Mexitil) Betapace AF) Norpace CR, Rhyth- modan)

Beta-Adrenergic Blockers Acebutolol (Sectral) Carteolol (Cartrol, Metoprolol (Lopressor, Atenolol Ocupress Toprol XL) (Tenormin) Ophthalmic) Nadolol (Corgard) Atenolol & Carvedilol (Coreg, Penbutolol (Levatol) Chlorthalidone Coreg CR) Pindolol (Visken) (Tenoretic) Labetalol (Trandate, Propranolol (Inderal) Betaxolol (Kerlone) Normodyne) Timolol (Blocadren) Bisoprolol (Zebeta)

Calcium Channel Antagonists Amlodipine (Norvasc) Isradipine (DynaCirc) Nimodipine (Nimotop) Diltiazem (Cardizem, Nicardipine (Cardene) Nisoldipine (Sular) Cartia XT, Dilacor, Nifedipine (Procardia, Verapamil (Calan, Diltia XT, Taztia XT, Procardia XL, Adalat, Isoptin, Verelan) Tiamate, Tiazac) Adalat CC) Felodipine (Plendil)

Centrally Acting Antihypertensive Agents Clonidine (Catapres) Methyldopa (Aldomet) 8 Nurse’s Pocket Drug Guide 2009

Diuretics Acetazolamide (Diamox) Hydrochlorothiazide & Indapamide (Lozol) Amiloride (Midamor) Amiloride (Moduretic) Mannitol Bumetanide (Bumex) Hydrochlorothiazide & Metolazone (Mykrox, Chlorothiazide (Diuril) Spironolactone Zaroxolyn) Chlorthalidone (Hygroton) (Aldactazide) Spironolactone Furosemide (Lasix) Hydrochlorothiazide & (Aldactone) Hydrochlorothiazide Triamterene (Dyazide, Torsemide (Demadex) (HydroDIURIL, Maxzide) Triamterene (Dyrenium) Esidrix) Inotropic/Pressor Agents Digoxin (Digitek, Epinephrine (Adrenalin, Nesiritide (Natrecor) Lanoxin, Lanoxicaps) Sus-Phrine, EpiPen) Norepinephrine Dobutamine (Dobutrex) Inamrinone (Inocor) (Levophed) Dopamine (Intropin) Isoproterenol (Isuprel) Phenylephrine Milrinone (Primacor) (Neo-Synephrine) Antihypertensive Combination Agents Amlodipine Besylate Isosorbide Dinitrate Benazepril Hy- Hydralazine HCL drochloride (Lotrel) (BiDil) Lipid-Lowering Agents Atorvastatin (Lipitor) Fenofibrate (TriCor, Lovastatin (Mevacor, Cholestyramine Antara, Lipofen, Altocor) (Questran) Triglide) Niacin (Niaspan) Colesevelam (WelChol) Fluvastatin (Lescol) Pravastatin (Pravachol) Colestipol (Colestid) Gemfibrozil Rosuvastatin (Crestor) Ezetimibe (Zetia) (Lopid) Simvastatin (Zocor)

Lipid-Lowering/Antihypertensive Combos Amlodipine/Atorvastatin (Caduet) Vasodilators Alprostadil [Prostaglandin Isosorbide Mononitrate Nitroprusside (Nipride, E1] (Prostin VR) (Ismo, Imdur) Nitropress) Epoprostenol (Flolan) Minoxidil (Loniten, Tolazoline (Priscoline) Fenoldopam (Corlopam) Rogaine) Treprostinil Sodium Hydralazine (Apresoline) Nitroglycerin (Nitrostat, (Remodulin) Iloprost (Ventavis) Nitrolingual, Nitro-Bid Isosorbide Dinitrate Ointment, Nitro-Bid IV, (Isordil, Sorbitrate, Nitrodisc, Dilatrate-SR) Transderm-Nitro) Classification 9

Miscellaneous Cardiovascular Agents Aliskiren (Tekturna) Conivaptan (Vaprisol) Ranolazine (Ranexa)

CENTRAL NERVOUS SYSTEM AGENTS Antianxiety Agents Alprazolam (Xanax) Diazepam (Valium, Lorazepam (Ativan) Buspirone (BuSpar) Diastat) Meprobamate (Equanil, Chlordiazepoxide Doxepin (Sinequan, Miltown) (Librium, Mitran, Adapin) Oxazepam Libritabs) Hydroxyzine (Atarax, Clorazepate (Tranxene) Vistaril)

Anticonvulsants Carbamazepine Lamotrigine (Lamictal) Phenytoin (Dilantin) (Tegretol) Levetiracetam (Keppra) Tiagabine (Gabitril) Clonazepam (Klonopin) Lorazepam (Ativan) Topiramate (Topamax) Diazepam (Valium) Oxcarbazepine Valproic Acid (Depakene, Ethosuximide (Trileptal) Depakote) (Zarontin) Pentobarbital (Nembutal) Zonisamide (Zonegran) Fosphenytoin (Cerebyx) Phenobarbital Gabapentin (Neurontin)

Antidepressants Amitriptyline (Elavil) Fluoxetine (Prozac, Paroxetine (Paxil) Bupropion (Wellbutrin, Sarafem) Phenelzine (Nardil) Zyban) Fluvoxamine (Luvox) Selegiline, transdermal Citalopram (Celexa) Imipramine (Tofranil) (Emsam) Desipramine (Norpramin) Mirtazapine (Remeron) Sertraline (Zoloft) Doxepin (Adapin) Nefazodone (Serzone) Trazodone (Desyrel) Duloxetine (Cymbalta) Nortriptyline (Aventyl, Venlafaxine (Effexor, Escitalopram (Lexapro) Pamelor) Effexor XR)

Antiparkinson Agents Amantadine (Symmetrel) Entacapone (Comtan) Selegiline (Eldepryl, Apomorphine (Apokyn) Pramipexole (Mirapex) Zelapar) Benztropine (Cogentin) Rasagiline mesylate Tolcapone (Tasmar) Bromocriptine (Parlodel) (Azilect) Trihexyphenidyl Carbidopa/Levodopa Ropinirole (Requip) (Artane) (Sinemet) 10 Nurse’s Pocket Drug Guide 2009

Antipsychotics Aripiprazole (Abilify) Mesoridazine (Serentil) Risperidone (Risperdal, Chlorpromazine Molindone (Moban) Risperdal Consta, (Thorazine) Olanzapine (Zyprexa) Risperdal M-Tab) Clozapine (Clozaril, Paliperidone (Invega) Thioridazine (Mellaril) FazaClo) Perphenazine (Trilafon) Thiothixene (Navane) Fluphenazine (Prolixin, Prochlorperazine Trifluoperazine Permitil) (Compazine) (Stelazine) Haloperidol (Haldol) Quetiapine (Seroquel, Ziprasidone (Geodon) Lithium Carbonate Seroquel XR) (Eskalith, Lithobid) Sedative Hypnotics Chloral Hydrate Flurazepam (Dalmane) Ramelteon (Rozerem) (Aquachloral, Hydroxyzine (Atarax, Quazepam (Doral) Supprettes) Vistaril) Secobarbital (Seconal) Diphenhydramine Midazolam Temazepam (Restoril) (Benadryl) Phenobarbital Triazolam (Halcion) Estazolam (ProSom) Pentobarbital (Nembutal) Zaleplon (Sonata) Eszopiclone (Lunesta) Propofol (Diprivan) Zolpidem (Ambien) Miscellaneous CNS Agents Atomoxetine HCL Methylphenidate, Oral Nimodipine (Nimotop) (Strattera) (Concerta, Ritalin, Rivastigmine (Exelon) Galantamine (Razadyne) Ritalin-SR, others) Sodium Oxybate Interferon beta-1a (Rebif) Methylphenidate, (Xyrem) Lisdexamfetamine Transdermal Tacrine (Cognex) (Vyvanse) (Daytrana) Memantine (Namenda) Natalizumab (Tysabri)

DERMATOLOGIC AGENTS Acitretin (Soriatane) Bacitracin & Polymyxin Bacitracin, Neomycin, Acyclovir (Zovirax) B, Topical (Polysporin) Polymyxin B, & Alefacept (Amevive) Bacitracin, Neomycin, & Lidocaine, Topical Amphotericin B Polymyxin B, Topical (Clomycin) (Fungizone) (Neosporin Ointment) Botulinum toxin type A Anthralin Bacitracin, Neomycin, (Botox Cosmetic) (Anthra-Derm) Polymyxin B, & Calcipotriene (Dovonex) Bacitracin, Topical Hydrocortisone, Capsaicin (Capsin, (Baciguent) Topical (Cortisporin) Zostrix) Classification 11

Ciclopirox (Loprox) Lactic Acid & Ammo- Podophyllin (Podocon-25, Ciprofloxacin (Cipro) nium Hydroxide [Am- Condylox Gel 0.5%, Clindamycin (Cleocin) monium Lactate] Condylox) Clotrimazole & (Lac-Hydrin) Pramoxine (Anusol Betamethasone Lindane (Kwell) Ointment, (Lotrisone) Lisdexamfetamine ProctoFoam-NS) Dapsone, Topical (Aczone) (Vyvanse) Pramoxine & Hydrocor- Dibucaine (Nupercainal) Metronidazole (Flagyl, tisone (Enzone, Doxepin, Topical MetroGel) Proctofoam-HC) (Zonalon, Prudoxin) Miconazole (Monistat) Selenium Sulfide (Exsel Econazole (Spectazole) Miconazole/Zinc Shampoo, Selsun Blue Efalizumab (Raptiva) Oxide/Petrolatum Shampoo, Selsun Erythromycin, Topical (Vusion) Shampoo) (A/T/S, Eryderm, Minocycline Silver Sulfadiazine Erycette, T-Stat) (Solodyn) (Silvadene) Finasteride (Propecia) Minoxidil (Loniten, Steroids, Topical (Table 4) Gentamicin, Topical Rogaine) Tacrolimus (Prograf, (Garamycin, Mupirocin (Bactroban) Protopic) G-Mycitin) Naftifine (Naftin) Tazarotene (Tazorac, Imiquimod Cream, 5% Neomycin Sulfate Avage) (Aldara) (Myciguent) Terbinafine (Lamisil) Isotretinoin [13-cis Nystatin (Mycostatin) Tolnaftate (Tinactin) Retinoic Acid] Oxiconazole (Oxistat) Tretinoin, Topical (Accutane, Amnes- Penciclovir (Denavir) [Retinoic Acid] teem, Claravis, Sotret) Permethrin (Nix, (Retin-A, Avita, Ketoconazole (Nizoral) Elimite) Renova) Kunecatechins (Veregen) Pimecrolimus (Elidel) Vorinostat (Zolinza)

DIETARY SUPPLEMENTS Calcium Acetate Ferric Gluconate Multivitamins (Table 13) (Calphron, Phos-Ex, Complex (Ferrlecit) Phytonadione [Vitamin PhosLo) Ferrous Gluconate K] (Aqua-MEPHY- Calcium Glubionate (Fergon) TON) (Neo-Calglucon) Ferrous Sulfate Potassium Supplements Calcium Salts [Chloride, Fish Oil (Omacor, OTC) (Kaon, Kaochlor, Gluconate, Folic Acid K-Lor, Slow-K, Gluceptate] Iron Dextran (DexFerrum, Micro-K, Klorvess) Cholecalciferol [Vitamin INFeD) Pyridoxine [Vitamin B6] D3] (Delta D) Iron Sucrose (Venofer) Sodium Bicarbonate Cyanocobalamin Magnesium Oxide [NaHCO3] [Vitamin B12] (Mag-Ox 400) Thiamine [Vitamin B1] (Nascobal) Magnesium Sulfate 12 Nurse’s Pocket Drug Guide 2009

EAR (OTIC) AGENTS Acetic Acid & Neomycin, Colistin, Sulfacetamide & Aluminum Acetate Hydrocortisone, & Prednisolone (Otic Domeboro) Thonzonium (Blephamide) Benzocaine & (Cortisporin-TC Triethanolamine Antipyrine Otic Suspension) (Cerumenex) (Auralgan) Polymyxin B & Ciprofloxacin, Otic Hydrocortisone (Cipro HC Otic) (Otobiotic Otic) Neomycin, Colistin, & Hydrocortisone (Cortisporin-TC Otic Drops)

ENDOCRINE SYSTEM AGENTS Antidiabetic Agents Acarbose (Precose) Insulins, Systemic Rosiglitazone/Metformin Chlorpropamide (Table 5) (Avandamet) (Diabinese) Metformin (Glucophage) Sitagliptin (Januvia) Glimepiride (Amaryl) Miglitol (Glyset) Sitagliptin/Metformin Glimepiride/pioglitazone Nateglinide (Starlix) (Janumet) (Duetact) Pioglitazone (Actos) Tolazamide (Tolinase) Glipizide (Glucotrol) Pioglitazone HCL/ Tolbutamide (Orinase) Glyburide (DiaBeta, Glimepiride (Duetact) Micronase, Pioglitazone/Metformin Glynase) (Actoplus Met) Glyburide/Metformin Repaglinide (Prandin) (Glucovance) Rosiglitazone (Avandia)

Hormone & Synthetic Substitutes Calcitonin (Cibacalcin, Fludrocortisone Acetate Prednisolone Miacalcin) (Florinef) Prednisone Calcitriol (Rocaltrol, Fluoxymesterone Testosterone (AndroGel, Calcijex) (Halotestin, Androxy) Androderm, Striant, Cortisone Systemic, Glucagon Testim) Topical Hydrocortisone Topical Vasopressin [Antidi- Desmopressin (DDAVP, & Systemic (Cortef, uretic Hormone, Stimate) Solu-Cortef) ADH] (Pitressin) Dexamethasone Methylprednisolone (Decadron) (Solu-Medrol) Classification 13

Hypercalcemia/Osteoporosis Agents Etidronate Disodium Ibandronate Sodium Zoledronic Acid (Didronel) (Boniva) (Zometa) Gallium Nitrate (Ganite) Pamidronate (Aredia)

Obesity Sibutramine (Meridia)

Osteoporosis Agents Alendronate (Fosamax) Risedronate (Actonel) Zoledronic Acid Raloxifene (Evista) Teriparatide (Forteo) (Zometa)

Thyroid/Antithyroid Levothyroxine Potassium iodide [Lugol Propylthiouracil [PTU] (Synthroid, Levoxyl) Solution] (SSKI, Liothyronine (Cytomel) Thyro-Block) Methimazole (Tapazole)

Miscellaneous Endocrine Agents Cinacalcet (Sensipar) Diazoxide (Proglycem) Demeclocycline (Declomycin)

EYE (OPHTHALMIC) AGENTS Glaucoma Agents Acetazolamide (Diamox) Dorzolamide & Timolol Moxifloxacin (Vigamox) Apraclonidine (Iopidine) (Cosopt) Neomycin, Polymyxin, Betaxolol, Ophthalmic Echothiophate Iodine & Hydrocortisone (Betopic) (Phospholine (Cortisporin Brimonidine (Alphagan P) Ophthalmic) Ophthalmic & Otic) Brinzolamide (Azopt) Epinastine (Elestat) Norfloxacin (Chibroxin) Carteolol (Cartrol, Latanoprost (Xalatan) Ofloxacin (Ocuflox Ocupress Ophthalmic) Levobunolol (A-K Beta, Ophthalmic) Ciprofloxacin, Ophthalmic Betagan) Rimexolone (Vexol (Ciloxan) Levocabastine (Livostin) Ophthalmic) Cyclosporine, Ophthalmic Levofloxacin (Levaquin, Timolol, Ophthalmic (Restasis) Quixin & Iquix (Timoptic) Dipivefrin (Propine) Ophthalmic) Trifluridine, Ophthalmic Dorzolamide (Trusopt) Lodoxamide (Alomide) (Viroptic) 14 Nurse’s Pocket Drug Guide 2009

Ophthalmic Antibiotics Bacitracin, Ophthalmic Ciprofloxacin, Oph- Ofloxacin (Floxin, (AK-Tracin thalmic (Ciloxan) Ocuflox Ophthalmic) Erythromycin, Ophthalmic) Bacitracin & Polymyxin Ophthalmic (Ilotycin Silver Nitrate B, Ophthalmic Ophthalmic) (Dey-Drop) (AK-Poly-Bac Gentamicin, Ophthalmic Sulfacetamide (Bleph-10, Ophthalmic, (Garamycin, Cetamide, Sodium Polysporin Genoptic, Gentacidin, Sulamyd) Ophthalmic) Gentak) Sulfacetamide & Pred- Bacitracin, Neomycin, Neomycin & Dexam- nisolone (Blephamide) & Polymyxin B (AK ethasone (AK- Tobramycin, Ophthalmic Spore Ophthalmic, Neo-Dex Ophthalmic, (AKTob, Tobrex) Neosporin NeoDecadron Tobramycin & Dexam- Ophthalmic) Ophthalmic) ethasone (TobraDex) Bacitracin, Neomycin, Neomycin, Polymyxin Trifluridine (Viroptic) Polymyxin B, & B, & Dexamethasone Hydrocortisone, (Maxitrol) Ophthalmic (AK Neomycin, Polymyxin Spore HC B, & Prednisolone Ophthalmic, Cor- (Poly-Pred tisporin Ophthalmic) Ophthalmic)

Miscellaneous Ophthalmic Agents Artificial Tears (Tears Dexamethasone, Oph- Naphazoline & Naturale) thalmic (AK-Dex Pheniramine Acetate Atropine Ophthalmic, Decadron (Naphcon A) Cromolyn Sodium Ophthalmic) Nepafenac (Nevanac) (Opticrom) Emedastine (Emadine) Olopatadine (Patanol) Cyclopentolate Ketorolac, Ophthalmic Pemirolast (Alamast) (Cyclogyl, (Acular, Acular LS, Rimexolone (Vexol Cyclate) Acular PF) Ophthalmic) Cyclopentolate with Ketotifen (Zaditor) Scopolamine Ophthalmic Phenylephrine Lodoxamide (Alomide) (Cyclomydril) Naphazoline (Albalon, Cyclosporine AK-Con, Naphcon, Ophthalmic others) (Restasis) Classification 15

GASTROINTESTINAL AGENTS Antacids Alginic Acid Aluminum Hydroxide Aluminum Hydroxide (Gaviscon) with Magnesium with Magnesium Aluminum Hydroxide Hydroxide (Maalox) Trisilicate (Gaviscon, (Amphojel, Aluminum Hydroxide Gaviscon-2) ALternaGEL) with Magnesium Calcium Carbonate Aluminum Hydroxide Hydroxide & (Tums, Alka-Mints) with Magnesium Simethicone Magaldrate (Riopan, Carbonate (Mylanta, Mylanta II, Lowsium) (Gaviscon) Maalox Plus) Simethicone (Mylicon)

Antidiarrheals Bismuth Subsalicylate Kaolin-Pectin (Kaodene, Loperamide (Imodium) (Pepto-Bismol) Kao-Spen, Kapectolin, Octreotide (Sandostatin, Diphenoxylate with Parepectolin) Sandostatin LAR) Atropine (Lomotil, Lactobacillus (Lactinex Paregoric [Camphorated Lonox) Granules) Tincture of Opium]

Antiemetics Aprepitant (Emend) Granisetron (Kytril) Prochlorperazine Chlorpromazine Meclizine (Antivert) (Compazine) (Thorazine) Metoclopramide Promethazine (Phenergan) Dimenhydrinate (Reglan, Clopra, Scopolamine (Scopace) (Dramamine) Octamide) Thiethylperazine Dolasetron (Anzemet) Nabilone (Cesamet) (Torecan) Dronabinol (Marinol) Ondansetron (Zofran) Trimethobenzamide Droperidol (Inapsine) Palonosetron (Aloxi) (Tigan)

Antiulcer Agents Cimetidine Lansoprazole Rabeprazole (Tagamet) (Prevacid) (AcipHex) Esomeprazole Nizatidine (Axid) Ranitidine Hydrochloride (Nexium) Omeprazole (Prilosec, (Zantac) Famotidine (Pepcid, Zegerid) Sucralfate (Carafate) Pepcid AC) Pantoprazole (Protonix) 16 Nurse’s Pocket Drug Guide 2009

Cathartics/Laxatives Bisacodyl Lactulose (Constulose, Polyethylene Glycol- (Dulcolax) Generlac, Chronulac, Electrolyte Solution Docusate Calcium Cephulac, (GoLYTELY, CoLyte) (Surfak) Enulose) Psyllium (Metamucil, Docusate Potassium Magnesium Citrate Serutan, EfferSyllium) (Dialose) Magnesium Hydroxide Sodium Phosphate Docusate Sodium (Doss, (Milk of Magnesia) (Visicol) Colace) Mineral Oil Sorbitol Glycerin Suppository

Enzymes Pancreatin (Pancrease, Cotazym, Creon, Ultrase)

Miscellaneous GI Agents Alosetron (Lotronex) Hyoscyamine (Anaspaz, Neomycin Sulfate Balsalazide (Colazal) Cystospaz, Levsin) (Neo-Fradin, generic) Budesonide Hyoscyamine, Atropine, Olsalazine (Dipentum) (Entocort EC) Scopolamine, & Phe- Pramoxine Dexpanthenol nobarbital (Donnatal) (Anusol Ointment, (Ilopan-Choline Oral, Infliximab (Remicade) ProctoFoam-NS) Ilopan) Lubiprostone (Amitiza) Pramoxine with Hydro- Dibucaine Mesalamine (Asacol, cortisone (Enzone, (Nupercainal) Lialda, Pentasa, ProctoFoam-HC) Dicyclomine (Bentyl) Rowasa) Propantheline Hydrocortisone, Metoclopramide (Pro-Banthine) Rectal (Anusol-HC (Reglan, Clopra, Sulfasalazine Suppository, Octamide) (Azulfidine) Cortifoam Rectal, Misoprostol (Cytotec) Vasopressin (Pitressin) Proctocort)

HEMATOLOGIC AGENTS Anticoagulants Ardeparin (Normiflo) Enoxaparin (Lovenox) Protamine Argatroban (Acova) Fondaparinux (Arixtra) Tinzaparin (Innohep) Bivalirudin (Angiomax) Heparin Warfarin (Coumadin) Dalteparin (Fragmin) Lepirudin (Refludan) Classification 17

Antiplatelet Agents Abciximab (ReoPro) Dipyridamole (Persantine) Reteplase (Retavase) Aspirin (Bayer, Ecotrin, Dipyridamole & Aspirin Ticlopidine (Ticlid) St. Joseph’s) (Aggrenox) Tirofiban (Aggrastat) Clopidogrel (Plavix) Eptifibatide (Integrilin)

Antithrombotic Agents Alteplase, Recombinant Aprotinin (Trasylol) Streptokinase (Streptase, [tPA] (Activase) Danaparoid (Orgaran) Kabikinase) Aminocaproic Acid Dextran 40 (Gentran 40, Tenecteplase (TNKase) (Amicar) Rheomacrodex) Urokinase (Abbokinase) Anistreplase (Eminase) Reteplase (Retavase)

Hematopoietic Stimulants Darbepoetin Alfa Filgrastim [G-CSF] Sargramostim (Aranesp) (Neupogen) [GM-CSF] (Leukine) Epoetin Alfa [Erythro- Oprelvekin (Neumega) poietin, EPO] Pegfilgrastim (Neulasta) (Epogen, Procrit)

Volume Expanders Albumin (Albuminar, Dextran 40 Plasma Protein Fraction Buminate, (Rheomacrodex) (Plasmanate) Albutein) Hetastarch (Hespan)

Miscellaneous Hematologic Agents Antihemophilic Factor Desmopressin (DDAVP, Pentoxifylline (Trental) VIII (Monoclate) Stimate) Decitabine (Dacogen) Lenalidomide (Revlimid)

IMMUNE SYSTEM AGENTS Immunomodulators Abatacept (Orencia) Interferon Alfacon-1 Natalizumab (Tysabri) Adalimumab (Humira) (Infergen) Peg Interferon Alfa-2b Anakinra (Kineret) Interferon Beta-1b (PEG-Intron) Etanercept (Enbrel) (Betaseron) Interferon Alfa Interferon Gamma-1b (Roferon-A, Intron A) (Actimmune) 18 Nurse’s Pocket Drug Guide 2009

Immunosuppressive Agents Azathioprine (Imuran) Muromonab-CD3 Sirolimus (Rapamune) Basiliximab (Simulect) (Orthoclone OKT3) Steroids, Systemic Cyclosporine (Sandim- Mycophenolic Acid (Table 3) mune, NePO) (Myfortic) Tacrolimus (Prograf, Daclizumab (Zenapax) Mycophenolate Mofetil Protopic) Lymphocyte Immune (CellCept) Globulin [Antithymocyte Globulin, ATG] (Atgam)

Vaccines/Serums/Toxoids Cytomegalovirus Hepatitis B Vaccine Meningococcal Immune Globulin (Engerix-B, Conjugate Vaccine [CMV-IG IV] Recombivax HB) (Menactra) (CytoGam) Human Papillomavirus Meningococcal Diphtheria, Tetanus (Types 6, 11, 16, 18) Polysaccharide Toxoids, & Acellular Recombinant Vaccine Vaccine (Menomune Pertussis Adsorbed, (Gardasil) A/C/Y/W-135) Hepatitis B Immune Globulin, IV Pneumococcal 7-Valent (recombinant), & (Gamimune N, Conjugate Vaccine Inactivated Poliovirus Sandoglobulin, (Prevnar) Vaccine (IPV) Gammar IV) Pneumococcal Vaccine, Combined Immune Globulin, Polyvalent (Pediarix) Subcutaneous (Pneumovax-23) Haemophilus B (Vivaglobin) Rotavirus Vaccine, live, Conjugate Vaccine Influenza Vaccine oral, pentavalent (ActHIB, HibTITER, (Fluarix, Flulaval, (RotaTeq) PedvaxHIB, Fluzone, Fluvirin) Tetanus Immune ProHIBIt) Influenza Virus Vaccine Globulin Hepatitis A Vaccine Live, Intranasal Tetanus Toxoid (Havrix, Vaqta) (FluMist) Varicella Virus Vaccine Hepatitis A (Inactivated) Measles, Mumps, (Varivax) & Hepatitis B Rubella, and Zoster Vaccine, live Recombinant Vaccine Varicella Virus (Zostavax) (Twinrix) Vaccine Live Hepatitis B Immune [MMRV] (ProQuad) Globulin (HyperHep, H-BIG) Classification 19

MUSCULOSKELETAL AGENTS Antigout Agents Allopurinol (Zyloprim, Colchicine Probenecid (Benemid) Lopurin, Aloprim) Sulfinpyrazone

Muscle Relaxants Baclofen (Lioresal Cyclobenzaprine Diazepam (Valium) Intrathecal) (Flexeril) Metaxalone (Skelaxin) Carisoprodol (Soma) Cyclobenzaprine, Methocarbamol Chlorzoxazone extended release (Robaxin) (Paraflex, Parafon (Amrix) Orphenadrine (Norflex) Forte DSC) Dantrolene (Dantrium)

Neuromuscular Blockers

Atracurium (Tracrium) Succinylcholine Vecuronium (Norcuron) Pancuronium (Pavulon) (Anectine, Quelicin, Rocuronium (Zemuron) Sucostrin)

Miscellaneous Musculoskeletal Agents Edrophonium (Tensilon, Leflunomide Methotrexate Enlon, Reversol) (Arava) (Rheumatrex)

OB/GYN AGENTS Contraceptives Copper IUD Contracep- Etonogestrel/Ethinyl Oral Contraceptives, tive (ParaGard T 380A) Estradiol (NuvaRing) Multiphasic (Table 6) Drospirenone/Ethinyl Levonorgestrel Implant Oral Contraceptives, Estradiol (YAZ) (Norplant) Progestin Only Estradiol Cypionate & Levonorgestrel/Ethinyl (Table 6) Medroxyprogesterone Estradiol (Seasonale) Oral Contraceptives, Acetate (Lunelle) Medroxyprogesterone Extended-Cycle Etonogestrel Implant (Provera, Depo- Combination (Table 6) (Implanon) Provera) Levonorgestrel intrauter- Norgestrel (Ovrette) ine device (IUD) Oral Contraceptives, (Mirena) Monophasic (Table 6) Emergency Contraceptives Ethinyl Estradiol & Levonorgestrel (Plan B) Levonorgestrel (Preven) 20 Nurse’s Pocket Drug Guide 2009

Estrogen Supplementation ESTROGEN ONLY Drospirenone/Estradiol Estradiol (Estrace, Estrogen, Conjugated- (Angelia) others) Synthetic (Cenestin, Esterified Estrogens Estradiol gel (Elestrin) Enjuvia) (Estratab, Menest) Estradiol, Transdermal Esterified Estrogens Esterified Estrogens with (Estraderm, Climara, (Estratab, Menest) Methyltestosterone Vivelle) (Estratest) Estrogen, Conjugated (Premarin)

COMBINATION ESTROGEN/PROGESTIN Esterified Estrogens with Estrogen, Conjugated Norethindrone Methyltestosterone with Methyltestos- Acetate/Ethinyl (Estratest, Estratest terone (Premarin with Estradiol (Ethinyl HS, Syntest DS, HS) Methyltestosterone) Estradiol/Norethindrone Estrogen, Conjugated Estradiol/Levonorgestrel, Acetate) with Medroxyproges- Transdermal terone (Prempro, (Climara Pro) Premphase) Estradiol/Norethindrone Estrogen, Conjugated acetate (FemHRT, with Methylproges- Activella) terone (Premarin with Methylprogesterone)

Vaginal Preparations Amino-Cerv pH 5.5 Miconazole (Monistat) Terconazole (Terazol 7) Cream Nystatin (Mycostatin) Tioconazole (Vagistat) Lutrepulse

Miscellaneous Ob/Gyn Agents Dinoprostone (Cervidil Magnesium Sulfate Oxytocin (Pitocin) Vaginal Insert, Medroxyprogesterone Terbutaline (Brethine, Prepidil Vaginal Gel, (Provera, Depo- Bricanyl) Prostin E2) Provera) Gonadorelin Methylergonovine (Factrel) (Methergine) Leuprolide (Lupron) Mifepristone [RU 486] Lutropin Alfa (Mifeprex) (Luveris) Classification 21

PAIN MEDICATIONS Local Anesthetics (Table 2) Benzocaine & Antipyrine Cocaine Lidocaine & Prilocaine (Auralgan) Dibucaine (EMLA, LMX) Bupivacaine (Marcaine) (Nupercainal) Pramoxine (Anusol Capsaicin (Capsin, Lidocaine (Anestacon Ointment, Procto- Zostrix) Topical, Xylocaine) Foam-NS) Migraine Headache Medications Acetaminophen with Almotriptan (Axert) Eletriptan (Relpax) Butalbital w/and w/o Aspirin & Butalbital Frovatriptan (Frova) Caffeine (Fioricet, Compound (Fiorinal) Naratriptan (Amerge) Medigesic, Repan, Aspirin with Butalbital, Sumatriptan (Imitrex) Sedapap-10, Two- Caffeine, & Codeine Zolmitriptan (Zomig) Dyne, Triapin, Axocet, (Fiorinal with Phrenilin Forte) Codeine) Narcotic Analgesics Acetaminophen with Hydrocodone & Morphine, Liposomal Codeine Acetaminophen (Lorcet, (DepoDur) (Tylenol No. 3, 4) Vicodin, Hycet) Nalbuphine (Nubain) Alfentanil (Alfenta) Hydrocodone & Aspirin Oxycodone (OxyContin, Aspirin with Codeine (Lortab ASA) OxyIR, Roxicodone) (Empirin No. 2, 3, 4) Hydrocodone & Ibupro- Oxycodone & Aceta- Buprenorphine fen (Vicoprofen) minophen (Percocet, (Buprenex) Hydromorphone Tylox) Butorphanol (Stadol) (Dilaudid) Oxycodone & Aspirin Codeine Levorphanol (Percodan, Percodan- Fentanyl (Sublimaze) (Levo-Dromoran) Demi) Fentanyl Iontophoretic Meperidine (Demerol) Oxymorphone HCl Transdermal System Methadone (Dolophine) (Opana, Opana ER) (Ionsys) Morphine (Avinza XR, Pentazocine (Talwin) Fentanyl, Transdermal Duramorph, Infu- Propoxyphene (Darvon) (Duragesic) morph, MS Contin, Propoxyphene & Aceta- Fentanyl, Transmucosal Kadian SR, Oramorph minophen (Darvocet) (Actiq, Fentora) SR, Palladone, Rox- Propoxyphene & Aspirin anol) (Darvon Compound-65, Darvon-N with Aspirin) Nonnarcotic Analgesics Acetaminophen [APAP] Tramadol Tramadol/ (Tylenol) (Ultram, Acetaminophen Aspirin (Bayer, Ecotrin, Ultram ER) (Ultracet) St. Joseph’s) 22 Nurse’s Pocket Drug Guide 2009

Nonsteroidal Anti-inflammatory Agents Celecoxib (Celebrex) Ibuprofen (Motrin, Naproxen (Aleve, Diclofenac (Cataflam, Rufen, Advil) Naprosyn, Anaprox) Flector, Voltaren) Indomethacin (Indocin) Oxaprozin (Daypro) Diflunisal (Dolobid) Ketoprofen (Orudis, Piroxicam (Feldene) Etodolac Oruvail) Sulindac (Clinoril) Fenoprofen (Nalfon) Ketorolac (Toradol) Tolmetin (Tolectin) Flurbiprofen (Ansaid, Meloxicam (Mobic) Ocufen) Nabumetone (Relafen)

Miscellaneous Pain Medications Amitriptyline (Elavil) Pregabalin (Lyrica) Ziconotide (Prialt) Imipramine (Tofranil) Tramadol (Ultram)

RESPIRATORY AGENTS Antitussives, Decongestants, & Expectorants Acetylcysteine Guaifenesin & Hydrocodone, (Acetadote, Mucomyst) Dextromethorphan Chlorpheniramine, Benzonatate (Tessalon Hydrocodone & Phenylephrine, Perles) Guaifenesin (Hycotuss Acetaminophen, & Codeine Expectorant) Caffeine (Hycomine) Dextromethorphan Hydrocodone & Potassium Iodide (SSKI, (Mediquell, Benylin Homatropine Thyro-Block) DM, PediaCare 1) (Hycodan, Hydromet) Pseudoephedrine Guaifenesin (Robitussin) Hydrocodone & (Sudafed, Novafed, Guaifenesin & Codeine Pseudoephedrine Afrinol) (Robitussin AC, (Detussin, Histussin-D) Brontex)

Bronchodilators Albuterol (Proventil, Formoterol (Foradil Salmeterol (Serevent, Ventolin, Volmax) Aerolizer) Serevent Diskus) Albuterol & Ipratropium Isoproterenol (Isuprel) Terbutaline (Brethine, (Combivent) Levalbuterol (Xopenex, Bricanyl) Aminophylline Xopenex HFA) Theophylline (Theo24, Arformoterol (Brovana) Metaproterenol TheoChron) Ephedrine (Alupent, Metaprel) Epinephrine (Adrenalin, Pirbuterol (Maxair) Sus-Phrine, EpiPen) Classification 23

Respiratory Inhalants Acetylcysteine (Aceta- Calfactant (Infasurf) Fluticasone Propionate dote, Mucomyst) Cromolyn Sodium (Intal, & Salmeterol Beclomethasone Nasalcrom, Opticrom) Xinafoate (Advair (Beconase, Vancenase Dexamethasone, Nasal Diskus, Advair HFA) Nasal Inhaler) (Dexacort Phosphate Ipratropium (Atrovent Beclomethasone (QVAR) Turbinaire) HFA, Atrovent Nasal) Beractant (Survanta) Flunisolide (AeroBid, Nedocromil (Tilade) Budesonide (Rhinocort, Aerospan, Nasarel) Tiotropium (Spiriva) Pulmicort) Fluticasone, Oral, Nasal Triamcinolone Budesonide/formoterol (Flonase, Flovent) (Azmacort) (Symbicort)

Miscellaneous Respiratory Agents

Alpha1-Protease Dornase Alfa Zafirlukast (Accolate) Inhibitor (Pulmozyme, Dnase) Zileuton (Zyflo) (Prolastin) Montelukast (Singulair) Omalizumab (Xolair)

URINARY/GENITOURINARY AGENTS Alprostadil, Intracaver- Methenamine (Hiprex, Potassium Citrate nosal (Caverject, Edex) Urex) (Urocit-K) Alprostadil, Urethral Neomycin-Polymyxin Potassium Citrate & Citric Suppository (Muse) Bladder Irrigant Acid (Polycitra-K) Ammonium Aluminum [Neosporin GU Sildenafil (Viagra) Sulfate [Alum] Irrigant] Solifenacin (VESIcare) Belladonna & Opium Nitrofurantoin (Macro- Sodium Citrate/Citric Suppositories (B & O dantin, Furadantin, Acid (Bicitra) Supprettes) Macrobid) Tadalafil (Cialis) Bethanechol Oxybutynin (Ditropan, Tolterodine (Detrol, (Urecholine, Duvoid) Ditropan XL) Detrol LA) Darifenacin (Enablex) Oxybutynin Transdermal Trimethoprim Dimethyl Sulfoxide System (Oxytrol) (Trimpex, [DMSO] (Rimso 50) Pentosan Polysulfate Proloprim) Flavoxate (Urispas) (Elmiron) Trospium Chloride Hyoscyamine (Anaspaz, Phenazopyridine (Sanctura) Cystospaz, Levsin) (Pyridium) Vardenafil (Levitra) Benign Prostatic Hyperplasia Medications Alfuzosin (Uroxatral) Dutasteride (Avodart) Tamsulosin (Flomax) Doxazosin (Cardura, Finasteride (Proscar) Terazosin (Hytrin) Cardura XL) 24 Nurse’s Pocket Drug Guide 2009

WOUND CARE Becaplermin (Regranex Silver Nitrate Gel) (Dey-Drop) MISCELLANEOUS THERAPEUTIC AGENTS Acamprosate (Campral) Naltrexone (Depade, Potassium Iodide [Lugol Alglucosidase alfa ReVia, Vivitrol) Solution] (SSKI, (Myozyme) Nicotine Gum (Nicorette, Thyro-Block) Cilostazol (Pletal) others) Sevelamer (Renagel) Drotrecogin Alfa (Xigris) Nicotine Nasal Spray Sodium Polystyrene Eculizumab (Soliris) (Nicotrol NS) Sulfonate Lanthanum Carbonate Nicotine, Transdermal (Kayexalate) (Fosrenol) (Habitrol, Nicoderm, Talc (Sterile Talc Powder) Mecasermin (Increlex) Nicotrol, others) Varenicline (Chantix) Megestrol Acetate Orlistat (Xenical, Alli (Megace) [OTC]) Palifermin (Kepivance) NATURAL & HERBAL AGENTS Aloe Vera Aloe Cranberry Vaccinium Horsetail Equisetum barbadensis macrocarpon arvense Arnica (Arnica montana) Dong Quai (Angelica Kava Kava (Piper Butcher’s Broom polymorpha, sinensis) methysticum) (Ruscus aculeatus) Echinacea (Echinacea Licorice (Glycyrrhiza Bilberry Vaccinium purpurea) glabra) myrtillus Ephedra/Ma Huang Melatonin (MEL) Black Cohosh (Cimi- Evening Primrose Oil Milk thistle (Silybum cifuga racemosa) Oenothera biennis marianum) Bogbean Menyanthes Feverfew (Tanacetum Nettle Urtica dioica trifoliate parthenium) Rue Ruta graveolens Borage Borago officinalis Garlic (Allium sativum) Saw Palmetto (Serenoa Bugleweed Lycopus Gentian Gentiana lutea repens) virginicus Ginger (Zingiber officinale) Spirulina (Spirulina spp) Capsicum Capsicum Ginkgo biloba Stevia Stevia rebaudiana frutescens Ginseng (Panax quin- St. John’s Wort (Hyper- Cascara Sagrada Rham- quefolius) icum perforatum) nus purshiana Glucosamine Sulfate Tea Tree (Melaleuca Chamomile (Matricaria (chitosamine) alternifolia) recutita) Green Tea Camellia Valerian (Valeriana offic- Chondroitin Sulfate sinensis inalis) Comfrey Symphytum Guarana Paullinia Yohimbine (Pausinys- officinale cupana talia yohimbe) Coriander Coriandrum Hawthorn (Crataegus sativum laevigata) GENERIC AND SELECTED BRAND DRUG DATA

Abacavir (Ziagen) [Antiretroviral/NRTI] WARNING: Allergy (fever, rash, fatigue, GI, resp) reported; stop drug immediately & do not rechallenge; lactic acidosis & hepatomegaly/steatosis reported Uses: *HIV Infxn* Action: Nucleoside RT Inhibitor Dose: Adults. 300 mg PO bid or 600 mg PO daily Peds. 8 mg/kg bid Caution: [C, –] CDC recommends HIV-infected mothers should not breast-feed (transmission risk) Disp: Tabs 300 mg; soln 20 mg/mL SE: See Warn- ing, ↑ LFTs, fat redistribution Interactions: EtOH ↓ drug elimination and ↑ drug exposure Labs: Monitor LFTs, FBS, CBC & differential, BUN & Cr, triglycerides NIPE: N EtOH; monitor & teach pt about hypersensitivity Rxns; D/C drug immediately if hypersensitivity Rxn occurs and N rechallenge; take w/ or w/o food Abatacept (Orencia) [Immunomodulator] Uses: *Mod/severe RA w/ inadequate response to one or more DMARDs* Action: Selective costimu- lation modulator, ↓ T-cell activation Dose: Initial 500 mg (<60 kg), 750 mg (60–100 kg); 1 g (>100 kg) IV over 30 min; repeat at 2 and 4 wk, then every 4 wk Caution: w/ TNF blockers [C, ?/–] COPD; h/o recurrent/localized/chronic, predisposition to Infxn Contra: w/ TNF antagonists (↑ Infxn) Disp: IV powder: 250 mg/10 mL SE: HA, URI, N, nasopharyngitis, Infxn, malignancy, inf Rxns/hypersensitivity (dizziness, HA, HTN), COPD exacerbations, cough, dyspnea Interactions: Do not give w/ live vaccines w/ or w/in 3 mo D/C Abatacept NIPE: Screen for TB prior to use; D/C if serious Infxn occurs Abciximab (ReoPro) [Platelet-Aggregation Inhibitor/ Antiplatelet] Uses: *Prevent acute ischemic complications in PTCA*, MI Action: ↓ plt aggregation (glycoprotein IIb/IIIa inhibitor) Dose: Unstable angina w/ planned PCI (ECC 2005): 0.25 μg/kg bolus, then 10 μg/min cont inf × 18–24 h, stop 1 h after PCI; PCI: 0.25 mg/kg bolus 10–60 min pre-PTCA, then 0.125 μg/kg/min (max=10 μg/min) cont inf for 12 h Caution: [C, ?/–] Contra: Active or recent (w/in 6 wk) internal hemorrhage, CVA w/in 2 y or CVA w/ significant neurologic deficit, bleeding diathesis or PO anticoagulants w/in 7 d (unless PT<1.2 × control), ↓ plt (<100,000 cells/μL), recent trauma or major surgery (w/in 6 wk), CNS tumor, AVM, aneurysm, severe uncontrolled HTN, vasculitis, use of dextran prior to or during PTCA, allergy to murine proteins Disp: Inj 2 mg/mL SE: Aller- gic Rxns, bleeding, ↓ plt Notes: Use w/ heparin/ASA Interactions: May ↑ bleeding W/ anticoagulants, antiplts, NSAIDs, thrombolytics Labs: Monitor CBC, PT, PTT, INR, guaiac stools, urine for blood NIPE: Monitor for ↑ bleeding & bruising; N shake vial or mix w/ another drug, N contact sports

Acamprosate (Campral) [Hypoglycemic/Alpha-glucosidase Inhibitor] Uses: *Maint abstinence from EtOH* Action: ↓ Glutamatergic transmission; modulates neuronal hyperexcitability; related to GABA Dose: 666 mg PO tid; CrCl 30–50 mL/min: 333 mg PO tid Caution: [C, ?/–] Contra: CrCl<30 mL/min Disp: Tabs 333 mg EC SE: N/D, depression, anxiety, insomnia Notes: Does not eliminate EtOH withdrawal Sx; continue even if relapse occurs Interac- tions: None Labs: ↑ BS, LFTs, uric acid; ↑ Hgb, Hct, plts NIPE: Caution w/ elderly & pts w/ h/o suicide ideations or depression; take w/o regard to food & swallow whole; N make-up missed dose or take >3 doses in 24 h Acarbose (Precose) [Hypoglycemic/Alpha-Glucosidase In- hibitor] Uses: *Type 2 DM* Action: α-Glucosidase inhibitor; delays digestion of carbohydrates to ↓ glucose Dose: 25–100 mg PO tid w/ 1st bite of each meal; 50 mg tid (<60 kg); 100 mg tid (>60 kg) Caution: [B, ?] Avoid w/ CrCl <25 mL/min; can affect digoxin levels Contra: IBD, colonic ulceration, partial intestinal obst; cirrhosis Disp: Tabs 25, 50, 100 mg SE: Abd pain, D, flatulence, ↑ LFTs, hypersensitivity Rxn Notes: OK w/ sulfonylureas; Interactions: ↑ Hypoglycemic effect W/ juniper berries, ginseng, garlic, coriander, celery; ↓ effects W/ intestinal absorbents, digestive enzyme Preps, diuretics, corticosteroids, phenothiazides, estrogens, phenytoin, INH, sympathomimetics, CCBs, thyroid hormones; ↓ conc OF digoxin Labs: LFTs q3mo for 1st y, FBS, HbA1c, LFTs, Hgb & Hct, monitor digoxin levels NIPE: Take drug tid w/ 1st bite of food, ↓ GI side effects by ↓ dietary starch, treat hypoglycemia w/ dextrose instead of sucrose, continue diet & exercise program Acebutolol (Sectral) [Antihypertensive, Antiarrhythmic/ Beta-Blocker] Uses: *HTN, arrhythmias* angina Action: Blocks β-adrenergic receptors, β1, & ISA Dose: HTN: 200–800 mg/d; arrhythmia: 400–1200 mg/d ÷ doses; ↓ if CrCl <50 mL/min or elderly; elderly initial 200–400 mg/d; max 800 mg/d Caution: [B, D in 2nd & 3rd tri, +] Can exacerbate ischemic heart Dz, do not D/C abruptly Contra: 2nd-, 3rd-degree heart block Disp: Caps 200, 400 mg SE: Fatigue, HA, dizziness, bradycardia Interactions: ↓ Antihypertensive effect W/ NSAIDs, salicylates, thyroid preps, anesthetics, antacids, α-adrenergic stimulants, ma-huang, ephedra, licorice; ↓ hypoglycemic effect OF glyburide; ↑ hypotensive response W/ other antihypertensives, nitrates, EtOH, diuretics, black cohash, hawthorn, goldenseal, parsley; ↑ bradycardia W/ digoxin, amiodarone; ↑ hypoglycemic effect OF insulin Labs: Monitor lipids, uric acid, K+, FBS, LFTs, thy- roxin, ECG NIPE: Teach pt to monitor BP, pulse, S/Sxs CHF Acetaminophen (APAP, N-acetyl-p-aminophenol) (Tylenol, other generic) [OTC] [Analgesic, Antipyretic] Uses: *Mild-moderate pain, HA, fever* Action: Nonnarcotic analgesic; ↓ CNS synth of prostaglandins & hypothalamic heat-regulating center Dose: Adults. 650 mg PO or PR q4–6h or 1000 mg PO q6h; max 4 g/24 h. Peds. <12 y 10–15 mg/kg/dose PO or PR q4–6h; max 2.6 g/ 24 h. See Table 1. Administer q6h if CrCl 10–50 mL/min & q8h if CrCl <10 mL/min Acetaminophen + Codeine 27

Caution: [B, +] Hepatotoxic in elderly & w/ EtOH use w/ >4 g/d; alcoholic liver Dz Contra: G6PD deficiency Disp: Tabs meltaway/dissolving 160 mg; tabs: 325, 500, 650 mg; chew tabs 80, 160 mg; Liq 100 mg/mL, 120 mg/2.5 mL, 120 mg/5 mL, 160 mg/5 mL, 167 mg/5 mL, 325 mg/5 mL, 500 mg/15 mL, 80 mg/0.8 mL; supp 80, 120, 125, 325, 650 mg SE: OD hepatotox at 10 g; 15 g can be lethal Rx w/ N- acetylcysteine Notes: No anti-inflammatory or plt-inhibiting action Interactions: ↑ Hepatotox W/ EtOH, barbiturates, carbamazepine, INH, rifampin, phenytoin; ↑ risk of bleeding W/ NSAIDs, salicylates, warfarin, feverfew, ginkgo biloba, red clover; ↓ absorption W/ antacids, cholestyramine, colestipol Labs: Monitor LFTs, CBC, BUN, Cr, PT, INR; false ↑ urine 5-HIAA, urine glucose, serum uric acid; false ↓ serum glucose, amylase NIPE: Delayed absorption if given w/ food, N EtOH, teach S/Sxs hepatotox, consult health care provider if temp ↑ 103°F/>3 d Acetaminophen + Butalbital ± Caffeine (Fioricet, Medigesic, Repan, Sedapap-10, Two-Dyne, Triapin, Axocet, Phrenilin Forte) [C-III] [Analgesic, Antipyretic/Barbiturate] Uses:*Tension HA,* mild pain Action: Nonnarcotic analgesic w/ barbiturate Dose: 1–2 tabs or caps PO q4/6h PRN; ↓ in renal/hepatic impair; 4 g/24 h APAP max Caution: [C, D, +] Alcoholic liver Dz Contra: G6PD deficiency Disp: Caps Dolgic Plus: Butalbital 50 mg, caffeine 40 mg, APAP 750 mg; caps Medigesic, Repan, Two-Dyne: Butalbital 50 mg, caffeine 40 mg, + APAP 325 mg; caps Axocet, Phrenilin Forte: Butalbital 50 mg + APAP 650 mg; caps: Esgic-Plus, Zebutral: Butalbital 50 mg, caffeine 40 mg, APAP 500 mg; Liq. Dolgic LQ: Butalbital 50 mg, caffeine 40 mg, APAP 325 mg/15mL; tabs Medigesic, Fioricet, Repan: Butalbital 50 mg, caffeine 40 mg, APAP 325 mg; Phre- nilin: Butalbital 50 mg + APAP 325 mg; Sedapap-10: Butalbital 50 mg + APAP 650 mg SE: Drowsiness, dizziness, “hangover” effect Interactions: ↑ Effects OF benzodiazepines, opiate analgesics, sedatives/hypnotics, EtOH, methylphenidate hydrochloride; ↓ effects OF MAOIs, TCAs, corticosteroids, theophylline, OCPs, BBs, doxycycline NIPE: N EtOH & CNS depressants, may impair coordination, monitor for depression, use barrier protection contraception; butalbital is habit forming Acetaminophen + Codeine (Tylenol No. 3, No. 4) [C-III, C-V] [Analgesic, Antipyretic/Opiate] Uses: *Mild–moderate pain (No. 3); moderate–severe pain (No. 4)* Action: Combined APAP & narcotic analgesic Dose: Adults. 1–2 tabs q3–4h PRN (max dose APAP = 4 g/d). Peds. APAP 10–15 mg/kg/dose; codeine 0.5–1 mg/kg dose q4–6h (guide: 3–6 y, 5 mL/dose; 7–12 y, 10 mL/dose); ↓ in renal/hepatic impair Caution: [C, +] Alcoholic liver Dz Contra: G6PD deficiency Disp: Tabs 300 mg APAP + codeine; caps 325 mg APAP + codeine; susp (C-V) APAP 120 mg + codeine 12 mg/5 mL SE: Drowsiness, dizziness, N/V Notes: Codeine in No. 3=30 mg, No. 4=60 mg Interactions: ↑ Effects OF benzodiazepines, opiate analgesics, sedatives/hypnotics, EtOH, methylphenidate hydrochloride; ↓ effects OF MAOIs, TCAs, corticosteroids, theophylline, OCPs, BBs, doxycycline NIPE: N EtOH & CNS depressants, may impair coordination, monitor for depression, use barrier protection contraception; codiene may be habit forming 28 Acetazolamide

Acetazolamide (Diamox) [Anticonvulsant, Diuretic/Carbonic Anhydrase Inhibitor] Uses: *Diuresis, glaucoma, prevent high-altitude sickness, refractory epilepsy* Action: Carbonic anhydrase inhibitor; ↓ renal excre- ↑ + + – tion of hydrogen & renal excretion of Na , K , HCO3 , H2O Dose: Adults. Diuretic: 250–375 mg IV or PO q24h. Glaucoma: 250–1000 mg PO q24h in ÷ doses. Epilepsy: 8–30 mg/kg/d PO in ÷ doses. Altitude sickness: 250 mg PO q8–12h or SR 500 mg PO q12–24h start 24–48 h before & 48 h after highest as- cent. Peds. Epilepsy: 8–30 mg/kg/24 h PO in ÷ doses; max 1 g/d. Diuretic: 5 mg/kg/ 24 h PO or IV. Alkalinization of urine: 5 mg/kg/dose PO bid-tid. Glaucoma: 5–15 mg/kg/24 h PO in ÷ doses; max 1 g/d; ↓ dose w/CrCl 10–50 mL/min; avoid if CrCl <10 mL/min Caution: [C, +] Contra: Renal/hepatic failure, sulfa allergy Disp: Tabs 125, 250 mg; ER caps 500 mg; inj 500 mg/vial, powder for recons SE: Malaise, metallic taste, drowsiness, photosens, hyperglycemia Interactions: Causes ↑ effects OF amphetamines, quinidine, procainamide, TCAs, ephedrine; ↓ effects OF Li, phenobarbital, salicylates, barbiturates; ↑ K+ loss W/ corticosteroids and amphotericin B Labs: Monitor serum electrolytes esp Na+ & K+, CBC, Cr, plt & intraocular pressure; false + for urinary protein, urinary urobilinogen; ↓ I uptake; ↑ serum & urine glucose, uric acid, Ca2+, serum ammonia NIPE: ↓ GI distress w/ food, monitor for S/Sxs metabolic acidosis, ↑ fluid to ↓ risk of kidney stones; ER forms not for epilepsy Acetic Acid & Aluminum Acetate (Otic Domeboro) [Astringent/ Anti-infective] Uses: *Otitis externa* Action: Anti-infective Dose: 4–6 gtt in ear(s) q2–3h Caution: [C, ?] Contra: Perforated tympanic membranes Disp: 2% Otic soln SE: Local irritation NIPE: Burning w/ instillation or irrigation Acetylcysteine (Acetadote, Mucomyst) [Mucolytic/Amino acid derivative] Uses: *Mucolytic, antidote to APAP hepatotox/OD* adjuvant Rx chronic bronchopulm Dzs & CF* prevent contrast-induced renal dysfunction. Action: Splits mucoprotein disulfide linkages; restores glutathione in APAP OD to protect liver Dose: Adults & Peds. Nebulizer: 3–5 mL of 20% soln diluted w/ equal vol of H2O or NS tid-qid. Antidote: PO or NG: 140 mg/kg load, then 70 mg/kg q4h × 17 doses. (Dilute 1:3 in carbonated beverage or OJ) Aceta- dote: 150 mg/kg IV over 15 min, then 50 mg/kg over 4 h, then 100 mg/kg over 16 h; Prevention: 600 mg PO bid × 2 d Caution: [C, ?] Disp: Soln, inhaled, & oral 10%, 20%; Acetadote IV soln 20% SE: Bronchospasm (inhal), N/V, drowsiness, anaphylactoid Rxns w/ IV Notes: Activated charcoal adsorbs PO acetylcysteine for APAP ingestion; start Rx for APAP OD w/in 6–8 h Interactions: Discolors rubber, Fe, Cu, Ag; incompatible W/ multiple antibiotics—administer drugs separately Labs: Monitor ABGs & pulse oximetry w/ bronchospasm NIPE: Inform pt of ↑ productive cough, clear airway before aerosol administration, ↑ fluids to liquefy secretions, unpleasant odor will disappear & may cause N/V Acitretin (Soriatane) [Retinoid] WARNING: Must not be used by females who are pregnant or intend to become pregnant during therapy or for up to 3 y Adefovir 29 after D/C of therapy; EtOH must not be ingested during therapy or for 2 mo following cessation of therapy; do not donate blood for 3 y following cessation Uses: *Severe psoriasis*; other keratinization disorders (lichen planus, etc) Action: Retinoid-like activity Dose: 25–50 mg/d PO, w/ main meal; ↑ if no response by 4 wk to 75 mg/d Caution: [X, -] Renal/hepatic impair; in women of reproductive potential Contra: See Warning Disp: Caps 10, 25 mg SE: Cheilitis, skin peeling, alopecia, pruritus, rash, arthralgia, GI upset, photosens, thrombocytosis, hypertriglyceridemia Interactions: ↑ 1/2 life W/ EtOH use, ↑ hepatotox W/ MTX, ↓ effects OF progestin-only contraceptives Labs: Monitor LFTs, lipids, FBS, HbA1c NIPE: Use effective contraception; N donate blood for 3 y after Rx, teach pt S/Sxs pancreatitis; patient agreement/informed consent prior to use Acyclovir (Zovirax) [Antiviral/Synthetic Purine Nucleoside] Uses: *Herpes simplex & zoster Infxns* Action: Interferes w/ viral DNA synth Dose: Adults. Dose on IBW if obese >125% IBW PO: Initial genital herpes: 200 mg PO q4h while awake, 5 caps/d × 10 d or 400 mg PO tid × 7–10 d. Chronic suppression: 400 mg PO bid. Intermittent Rx: As initial Rx, except Rx for 5 d, or 800 mg PO bid, at prodrome. Herpes zoster: 800 mg PO 5×/d for 7–10 d. IV: 5–10 mg/kg/dose IV q8h. Topical: Initial herpes genitalis: Apply q3h (6×/d) for 7 d. Peds. 5–10 mg/kg/dose IV or PO q8h or 750 mg/m2/24 h ÷ q8h. Chickenpox: 20 mg/kg/dose PO qid; ↓ W/ CrCl <50 mL/min Caution: [B, +] Contra: Hypersensi- tivity to compound Disp: Caps 200 mg; tabs 400, 800 mg; susp 200 mg/5 mL; inj 500 mg/vial; 1000, inj soln 25 mg/mL, 50 mg/mL; oint 5% & cream 5% SE: Dizziness, lethargy, confusion, rash, inflammation at IV site; Interactions:↑ CNS SE W/ MTX & zidovudine, ↑ blood levels W/ probenecid Labs: Monitor BUN, SCr, LFTs, CBC; transient ↑ Cr/BUN NIPE: Start immediately w/ Sxs, ↑ hydration w/ IV dose, ↑ risk cervical cancer w/ genital herpes, ↑ length of Rx in immunocompromised pts, PO better than topical for herpes genitalis Adalimumab (Humira) [Antirheumatic/TNF Alpha Blocker] WARNING: Cases of TB have been observed; TB skin test prior to use; Hep B reactivation possible, invasive fungal and other opportunistic Infxns have been reported Uses: *Moderate-severe RA w/ an inadequate response to one or more DMARDs* Active arthritis w/ psoriatic arthritis Action: TNF-a inhibitor Dose: 40 mg SQ qowk; may ↑ 40 mg qwk if not on MTX Caution: [B, ?/-] Serious In- fxns & sepsis reported Disp: Prefilled 0.8 mL (40 mg) syringe SE: Inj site Rxns, serious Infxns, neurologic events, malignancies Notes: Refrigerate prefilled syringe, rotate inj sites, OK w/ other DMARDs Interactions: ↑ Effects W/ MTX Labs: May ↑ lipids, alk phosp, NIPE: N Exposure to Infxn; N admin live-virus vaccines Adefovir (Hepsera) [Antiviral/Acyclic Nucleotide Analogue] WARNING: Acute exacerbations of hepatitis may occur following D/C therapy (monitor LFTs); chronic use may lead to nephrotox w/ underlying renal impair (monitor renal Fxn); HIV resistance may emerge; lactic acidosis & severe hepatomegaly 30 Adenosine w/ steatosis reported alone or in combo w/ other antiretrovirals Uses: *Chronic active Hep B* Action: Nucleotide analog Dose: CrCl >50 mL/min: 10 mg PO daily; CrCl 20–49 mL/min: 10 mg PO q48h; CrCl 10–19 mL/min: 10 mg PO q72h; HD: 10 mg PO q7d postdialysis; adjust w/ CrCl <50 mL/min Caution: [C, -] Disp: Tabs 10 mg SE: Asthenia, HA, abd pain; see Warning Interactions: See Warning Labs: LFTs, BUN, Cr, creatine kinase, amylase NIPE: Effects on fetus & baby not known N breast-feed; use barrier contraception Adenosine (Adenocard) [Antiarrhythmic/Nucleoside] Uses: *PSVT*; including w/ WPW Action: Class IV antiarrhythmic; slows AV node conduction Dose: Adults. 6 mg over 1–3 s, then 20 mL NS bolus, elevate extremity; repeat 12 mg in 1–2 min PRN (ECC 2005) Peds. 0.05 mg/kg IV bolus; may repeat q1–2min to 0.3 mg/kg max Caution: [C, ?] Contra: 2nd- or 3rd-degree AV block or SSS (w/o pacemaker); recent MI or cerebral hemorrhage Disp: Inj 3 mg/mL SE: Facial flushing, HA, dyspnea, chest pressure, ↓ BP Interactions: ↓ Effects W/ theophylline, caffeine, guarana; ↑ effects W/ dipyridamole; ↑ risk OF hypotension & chest pain W/ nicotine; ↑ risk OF bradycardia W/ BBs; ↑ risk OF heart block W/ carbamazepine; ↑ risk OF ventricular fibrillation W/ digitalis glycosides Labs: Monitor ECG during administration NIPE: Monitor BP & pulse during therapy, monitor resp status ↑ risk of bronchospasm in asthmatics, discard unused or unclear soln; doses >12 mg not OK; can cause monentary asystole when administered Albumin (Albuminar, Buminate, Albutein) [Plasma Volume Expander] Uses: *Plasma volume expansion for shock* (eg, burns, hemorrhage) Action: Maint plasma colloid oncotic pressure Dose: Adults. Initial 25 g IV; then based on response; 250 g/48h max Peds. 0.5–1 g/kg/dose; inf at 0.05–0.1 g/min Caution: [C, ?] Severe anemia; cardiac, renal, or hepatic insuff due to protein load & hypervolemia Contra: CHF Disp: Soln 5%, 25% SE: Chills, fever, CHF, tachycardia, ↓ BP, hypervolemia Interactions: Atypical Rxns W/ ACEI withhold 24 h prior to plasma administration Labs: ↑ Alk phosp; monitor HMG, Hct, electrolytes, serum protein NIPE: Monitor BP & D/C if hypotensive, monitor intake & output, admin to all blood types; Contains 130–160 mEq Na+/L; may cause pulm edema Albuterol (Proventil, Ventolin, Volmax) [Bronchodilator/ Adrenergic] Uses: *Asthma; prevent exercise-induced bronchospasm* Action: β-adrenergic sympathomimetic bronchodilator; relaxes bronchial smooth muscle Dose: Adults. Inhaler: 2 inhal q4–6h PRN; 1 Rotacap inhaled q4–6h. PO: 2–4 mg PO tid-qid. Neb: 1.25–5 mg (0.25–1 mL of 0.5% soln in 2–3 mL of NS) tid-qid. Peds. Inhaler: 2 inhal q4–6h. PO: 0.1–0.2 mg/kg/dose PO; max 2–4 mg PO tid; Neb: 0.05 mg/kg (max 2.5 mg) in 2–3 mL of NS tid-qid Caution: [C, +] Disp: Tabs 2, 4 mg; XR tabs 4, 8 mg; syrup 2 mg/5 mL; 90 μg/dose met-dose inhaler; soln for neb 0.083, 0.5% SE: Palpitations, tachycardia, nervousness, GI upset Interactions: ↑ Effects W/ other sympathomimetics; ↑ CV effects Alefacept 31

W/ MAOI, TCA, inhaled anesthetics; ↓ effects W/ BBs; ↓ effectiveness OF insulin, oral hypoglycemics, digoxin Labs: Transient ↑ in serum glucose after inhalation; transient ↓ K+ after inhalation NIPE: Monitor HR, BP, ABGs, s&s bronchospasm & CNS stimulation; instruct on use of inhaler, must use as 1st inhaler, & rinse mouth after use Albuterol & Ipratropium (Combivent, DuoNeb) [Bron- chodilator/Adrenergic, Anticholinergic] Uses: *COPD* Action: Combo of β-adrenergic bronchodilator & quaternary anticholinergic Dose: 2 inhal qid; neb 3 mL q6h Caution: [C, +] Contra: Peanut/soybean allergy Disp: Met- dose inhaler, 18 μg ipratropium & 103 μg albuterol/puff; nebulization soln (DuoNeb) ipratropium 0.5 mg & albuterol 2.5 mg/3 mL 0.042%, 0.21% SE: Palpi- tations, tachycardia, nervousness, GI upset, dizziness, blurred vision Interactions: ↑ Effects W/ anticholinergics, including ophthalmic meds; ↓ effects W/ herb jaborandi tree, pill-bearing spurge NIPE: See Albuterol; may cause transient blurred vision/irritation or urinary changes Aldesleukin [IL-2] (Proleukin) [Immunomodulator/Antineo- plastic] WARNING: Use restricted to pts w/ nl pulm & cardiac Fxn Uses: *Met RCC & melanoma* Action: Acts via IL-2 receptor; many immunomodulatory effects Dose: 600,000 IU/kg q8h × 14 doses days 1–5 and days 15–19 of 28-d cycle (FDA-approved dose/schedule for RCC); other schedules (eg, “high dose” 24 × 106 IU/m2 IV q8h on days 1–5 & 12–16) Caution: [C, ?/-] Contra: Organ allo- grafts Disp: Powder for recons 22 × 106 IU, when reconstituted 18 million IU/mL = 1.1 mg/mL SE: Flu-like synd (malaise, fever, chills), N/V/D, ↑ bilirubin; capillary leak synd w/ ↓ BP, pulm edema, fluid retention, & wt gain; renal & mild hematologic tox (↓ HgB, plt,WBC), eosinophilia; cardiac tox (ischemia, atrial arrhythmias); neuro tox (CNS depression, somnolence, delirium, rare coma); pruritic rashes, urticaria, & erythroderma common. Notes: Cont inf ↓ risk severe ↓ BP & fluid retention Interactions: May ↑ tox OF cardiotoxic, hepatotoxic, myelotoxic, & nephrotoxic drugs; ↑ hypotension W/ antihypertensive drugs; ↓ effects W/ corticosteroids; acute Rxn W/ iodinated contrast media up to several months after inf; CNS effects W/ psychotropics Labs: May cause ↑ alkaline phosphatase, bilirubin, BUN, SCr, LFTs NIPE: Thoroughly explain serious side effects of drug & that some side effects are expected; N EtOH, NSAIDs, ASA Alefacept (Amevive) [Antipsoriatic/Immunosuppressive] WARNING: Must monitor CD4 before each dose; w/hold if <250; D/C if <250 × 1 month Uses: *Moderate/severe chronic plaque psoriasis* Action: Fusion protein inhibitor Dose: 7.5 mg IV or 15 mg IM once wk × 12 wk Caution: [B, ?/-] PRG registry; associated w/ serious Infxn Contra: Lymphopenia, HIV Disp: 7.5, 15-mg powder for recons vials SE: Pharyngitis, myalgia, inj site Rxn, malignancy, Infxn Interactions: No studies performed Labs: Monitor WBCs, CD4+ T lymphocyte counts NIPE: ↑ Risk of Infxn; N exposure to Infxns; inj site inflammation; rotate sites; IV and IM different formulations; may repeat course 12 wk later if CD4 OK 32 Alendronate

Alendronate (Fosamax, Fosamax Plus D) [Antiosteoporotic] Uses: *Rx & prevent osteoporosis male & female, Rx steroid-induced osteoporosis, Paget Dz* Action: ↓ Nl & abnormal bone resorption Dose: Osteoporosis: Rx: 10 mg/d PO or 70 mg qwk; Fosamax plus D 1 tab qwk. Steroid-induced osteoporosis: Rx: 5 mg/d PO. Prevention: 5 mg/d PO or 35 mg qwk. Paget Dz: 40 mg/d PO Caution: [C, ?] Not OK if CrCl <35 mL/min, w/ NSAID use Contra: Esophageal anomalies, inability to sit/stand upright for 30 min, ↓ Ca2+ Disp: Tabs 5, 10, 35, 40, 70 mg, soln 70 mg/75 mL, Foxamax plus D: Alendronate 70 mg and cholecalciferol 2800 IU SE: GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Notes: Take 1st thing in AM w/ H2O (8 oz) >30 min before 1st food/beverage of the day. Do not lie down for 30 min after. Ca2+ & vitamin D supl necessary for regular tab Interactions: ↓ Absorption W/ antacids, Ca supls, Fe, food; ↑ risk of upper GI bleed W/ ASA & NSAIDs Labs: May cause transient ↑ serum Ca & phosphate NIPE: Adequate Ca & vitamin D supl needed, ↑ wt- bearing activity, ↓ smoking, EtOH use Alfentanil (Alfenta) [Narcotic Analgesic] [C-II] Uses: *Adjunct in the maint of anesthesia; analgesia* Action: Short-acting narcotic analgesic Dose: Adults & Peds >12 y. 3–75 μg/kg (IBW) IV inf; total depends on duration of procedure Caution: [C, +/–] ↑ ICP, resp depression Disp: Inj 500 μg/mL SE: Bradycardia, ↓ BP arrhythmias, peripheral vasodilation, ↑ ICP, drowsiness, resp depression Interactions: ↓ Effect W/ phenothiazines; ↑ effects W/ BBs, CNS depressants, erythromycin NIPE: Monitor HR, BP, resp rate Alfuzosin (Uroxatral) [Selective Alpha Adrenergic Antago- nist] WARNING: May prolong QTc interval Uses: *BPH* Action: α-Blocker Dose: 10 mg PO daily immediately after the same meal Caution: [B, –] Contra: w/ CYP3A4 inhibitors; moderate-severe hepatic impair Disp: Tabs 10 mg SE: Pos- tural ↓ BP, dizziness, HA, fatigue Interactions: ↑ Effects W/ atenolol, azole antifungals, cimetidine, ritonavir; ↑ effects OF antihypertensives NIPE: Not indicated for use in women or children; take w/ food; ↑ risk of postural hypotension; N take other meds that prolong QT interval. N cut or crush XR tablet; Fewest reports of ejaculatory disorders compared w/ similar drugs Alginic Acid + Aluminum Hydroxide & Magnesium Trisili- cate (Gaviscon) [Antacid] [OTC] Uses: *Heartburn*; hiatal hernia pain Action: Protective layer blocks gastric acid Dose: 2–4 tabs or 15–30 mL PO qid + followed by H2O; Caution: [B, –] Avoid in renal impair or Na -restricted diet Disp: Tabs, susp SE: D, constipation Interactions: ↓ Absorption OF tetracyclines Alglucosidase alfa (Myozyme) [Recombinant Acid Alpha- Glucosidase] WARNING: Life-threatening anaphylactic Rxns have occurred w/ inf; appropriate medical support measures should be immediately available Uses: *Rx Pompe Dz* Action: Degrades glycogen in lysosomes Dose: 20 mg/kg IV q2wk over 4 h (see insert) Caution: [B,?/–] Illness at time of inf may Alosetron 33

↑ inf Rxns Disp: Powder 50 mg/vial SE: Hypersensitivity, fever, rash, D,V, gastroenteritis, pneumonia, URI, cough, respiratory distress, Infxns, cardiorespiratory failure, cardiac arrhythmia w/ general anesthesia Aliskiren (Tekturna) [Direct Renin Inhibitor] WARNING: May cause injury and death to a developing fetus; D/C immediately when pregnancy is detected Uses: HTN Action: Direct renin inhibitor Dose: 150–300 mg PO day Caution: [C (1st tri), D (2nd & 3rd tri), ?]; w/ severe renal impair Disp: Tabs 150, 300 mg SE: D, abd pain, dyspepsia, GERD, cough, ↑ K+, angioedema, ↓ BP Allopurinol (Zyloprim, Lopurin, Aloprim) [Xanthine Oxidase Inhibitor] Uses: *Gout, hyperuricemia of malignancy, uric acid urolithiasis* Ac- tion: ↓ Uric acid production Dose: Adults. PO: Initial 100 mg/d; usual 300 mg/d; max 800 mg/d. IV: 200–400 mg/m2/d (max 600 mg/24 h); (after meal w/ plenty of fluid) Peds. Only for hyperuricemia of malignancy if <10 y: 10 mg/kg/24 h PO or 200 mg/m2/d IV ÷ q6–8h; max 600 mg/24 h; ↓ in renal impair Caution: [C, M] Disp: Tabs 100, 300 mg; inj 500 mg/30 mL (Aloprim) SE: Rash, N/V, renal impair, angioedema Notes: Aggravates acute gout; begin after acute attack resolves; IV dose of 6 mg/mL final conc as single daily inf or ÷ 6-, 8-, or 12-h intervals Interactions: ↑ Ef- fect OF theophylline, oral anticoagulants; ↑ hypersensitivity Rxns W/ ACEIs, thiazide diuretics; ↑ risk of rash W/ ampicillin/amoxicillin; ↑ bone marrow depression W/ cyclophosphamide, azathioprine, mercaptopurine; ↓ effects W/ EtOH Labs: ↑ Alkaline phosphatase, bilirubin, LFTs NIPE: ↑ fluids to 2–3 L/d, take pc, may ↑ drowsiness Almotriptan (Axert) [Serotonin 5-HT1 Receptor Agonist] Uses: *Rx acute migraine* Action: Vascular serotonin receptor agonist Dose: Adults. PO: 6.25–12 mg PO, repeat in 2 h PRN; 2 dose/24h max PO dose; max 12 or 24 mg/d Caution: [C, ?/–] Contra: Angina, ischemic heart Dz, coronary artery vasospasm, hemiplegic or basilar migraine, uncontrolled HTN, ergot use, MAOI use w/in 14 d Disp: Tabs 6.25, 12.5 mg SE: N, somnolence, paresthesias, HA, dry mouth, weakness, numbness, coronary vasospasm, HTN Interactions: ↑ Serotonin effects OF SSRIs, ↑ vasoactive action OF ergot derivatives & 5-HT agonists, ↑ effects W/ erythromycin, ketoconazole, itraconazole, MAOIs, ritonavir, verapamil NIPE: N Ergot compounds or 5-HT agonist within 24 h of almotriptan; N use if pregnant or breast-feeding; concurrent use with SSRIs may cause serotonin synd; use only during migraine headache attack; avoid driving if drug causes drowsiness Alosetron (Lotronex) [Selective 5-HT3 Receptor Antagonist] WARNING: Serious GI side effects, some fatal, including ischemic colitis reported. May be prescribed only through participation in the prescribing program for Lotronex Uses: *Severe diarrhea-predominant IBS in women who fail conventional therapy* Action: Selective 5-HT3 receptor antagonist Dose: Adults. 0.5 mg PO bid; titrate to 1 mg bid max; D/C after 4 wk at max dose if Sxs not controlled Caution: [B, ?/–] Contra: h/o chronic/severe constipation, GI obst, strictures, toxic megacolon, GI perforation, adhesions, ischemic/ulcerative colitis, Crohn Dz, 34 Alpha1-Protease Inhibitor diverticulitis, thrombophlebitis, hypercoagulability Disp: Tabs 0.5, 1 mg SE: Con- stipation, abd pain, N Notes: D/C immediately if constipation or Sxs of ischemic colitis develop; pt must sign informed consent prior to use “patient–health care provider agreement” Interactions: ↑ Risk constipation W/ other drugs that ↓ GI motility, inhibits N-acetyltransferase, & may influence metabolism of INH, procainamide, hydralazine Labs: Monitor for ↑ ALT, AST, alk phosp, bilirubin NIPE: Administer w/o regard to food, eval effectiveness >4 wk Alpha1-Protease Inhibitor (Prolastin) [Respiratory Agent/ α Alpha Protease Inhibitor Replacement] Uses: * 1-Antitrypsin de- α ficiency*; pancinar emphysema Action: Replace human 1-protease inhibitor Dose: 60 mg/kg IV once/wk Caution: [C, ?] Contra: Selective IgA deficiencies w/ known IgA antibodies Disp: Inj 500 mg/20 mL, 1000 mg/40 mL powder for inj SE: Fever, dizziness, flulike Sxs, allergic Rxns Labs: Monitor for ↑ ALT, AST NIPE: Inf over 30 min, N mix w/ other drugs, use w/in 3 h of reconstitution Alprazolam (Xanax, Niravam) [Anxiolytic/Benzodiazepine] [C-IV] Uses: *Anxiety & panic disorders*, anxiety w/ depression Action: Ben- zodiazepine; antianxiety agent Dose: Anxiety: Initial, 0.25–0.5 mg tid; ↑ to 4 mg/d max ÷ doses. Panic: Initial, 0.5 mg tid; may gradually ↑ to response; ↓ in elderly, debilitated, hepatic impair Caution: [D, –] Contra: NAG, concomitant itra/ ketoconazole Disp: Tabs 0.25, 0.5, 1, 2 mg; Xanax XR 0.5, 1, 2, 3 mg; Niravam (orally disintegrating tabs) 0.25, 0.5, 1, 2 mg; soln 1 mg/mL SE: Drowsiness, fatigue, irritability, memory impair, sexual dysfunction, paradoxical Rxns Interac- tions: ↑ CNS depression W/ EtOH, other CNS depressants, narcotics, MAOIs, anesthetics, antihistamines, theophylline, herbs: kava kava, valerian; ↑ effect W/ OCPs, cimetidine, INH, disulfiram, omeprazole, valproic acid, ciprofloxacin, erythromycin, clarithromycin, phenytoin, verapamil, grapefruit juice; ↑ risk OF ketoconazole, itraconazole, digitalis tox, ↓ effectiveness OF levodopa; ↓ effect W/ carbamazepine, rifampin, rifabutin, barbiturates, cigarette smoking Labs: ↑ Alka- line phosphatase, may cause ↓ Hct & neutropenia NIPE: Monitor for resp depression; avoid abrupt D/C after prolonged use Alprostadil [Prostaglandin E1] (Prostin VR) [Vasodilator/ Prostaglandin] WARNING: Apnea in up to 12% of neonates especially <2 kg at birth Uses: *Conditions ductus arteriosus blood flow must be maintained* sustain pulm/systemic circulation until OR (eg, pulm atresia/stenosis, transposi- tion, etc) Action: Vasodilator (ductus arteriosus very sensitive), plt inhibitor Dose: 0.05 μg/kg/min IV; ↓ to lowest that maintains response Caution: [X, –] Contra: Neonatal resp distress synd Disp: Inj 500 μg/mL SE: Cutaneous vasodilation, Sz- like activity, jitteriness, ↑ temp, thrombocytopenia, ↓ BP; may cause apnea Inter- actions: ↑ Effects OF anticoagulants & antihypertensives, ↓ effects OF cyclosporine Labs:↓ Ca2+, fibrinogen NIPE: Dilute drug before administration, refrigerate & discard >24 h, central line preferred, flushing indicates catheter malpo- sition, apnea & bradycardia indicates drug overdose, keep intubation kit at bedside Altretamine 35

Alprostadil, Intracavernosal (Caverject, Edex) [GU Agent/ Prostaglandin] Uses: *Erectile dysfunction* Action: Relaxes smooth muscles, dilates cavernosal arteries, ↑ lacunar spaces and blood entrapment Dose: 2.5–60 μg intracavernosal; titrate in office Caution: [X, –] Contra: ↑ Risk of priapism (eg, sickle cell); penile deformities/implants; men in whom sexual activity inadvisable Disp: Caverject: 5, 10, 20, 40 μg powder for inj vials ± diluent syringes 10, 20, 40 μg amp. Caverject impulse: Self-contained syringe (29 gauge) 10 & 20 μg. Edex: 10, 20, 40 μg cartridges SE: Local pain w/ inj Interactions: ↑ Effects OF anticoagulants & antihypertensives, ↓ effects OF cyclosporine Labs: ↓ Fibrinogen NIPE: Vaginal itching and burning in female partners, N inj >3 × /wk or closer than 24 h/dose; Counsel about priapism, penile fibrosis, hematoma risks, titrate dose in office Alprostadil, Urethral Suppository (Muse) [GU Agent/ Prostaglandin] Uses: *Erectile dysfunction* Action: Urethral absorption; vasodilator, relaxes smooth muscle of corpus cavernosa Dose: 125–1000 μg system 5–10 min prior to sexual activity; may repeat ×1/24 hr; titrate in office Cau- tion: [X, –] Contra: ↑ priapism risk (eg, sickle cell) penile deformities/implants; men in whom sexual activity inadvisable Disp: 125, 250, 500, 1000 μg w/ transurethral delivery system SE: ↓ BP, dizziness, syncope, penile/testicular pain, urethral burning/bleeding, priapism Interactions: ↑ Effects OF anticoagulants & antihypertensives, ↓ effects OF cyclosporine Labs: ↓ Fibrinogen NIPE: No more than 2 supp/24 h, urinate prior to use; titrate dose in office Alteplase, Recombinant [tPA] (Activase) [Plasminogen Acti- vator/Thrombolytic Enzyme] Uses: *AMI, PE, acute ischemic stroke, & CV cath occlusion* Action: Thrombolytic; binds fibrin in thrombus, initiates fibrinolysis Dose: AMI: 15 mg IV over 1–2 min, then 0.75 mg kg (max 50 mg) over 30 min, then 0.5 mg/kg over next 60 min (max 35 mg)(ECC 2005) Stroke: 0.09 mg/kg IV over 1 min, then 0.81 mg/kg; max 90 mg) inf over 60 min (ECC 2005) Cath occlusion: 10–29 kg 1 mg/mL; ≥30 kg 2 mg/mL Caution: [C, ?] Contra: Active internal bleeding; uncontrolled HTN (SBP=>185 mm Hg/DBP=> 110 mm Hg); recent (w/in 3 mo) CVA, GI bleed, trauma; intracranial or intraspinal surgery or Dz (AVM/aneurysm/subarachnoid hemorrhage), prolonged cardiac massage; intracranial neoplasm, suspected aortic dissection, bleeding/hemostatic defects, Sz at the time of stroke Disp: Powder for inj 2, 50, 100 mg SE: Bleeding, bruising (eg, venipuncture sites), ↓ BP Interactions: ↑ Risk of bleeding W/ heparin, ASA, NSAIDs, abciximab, dipyridamole, eptifibatide, tirofiban; ↓ effects W/ nitroglycerine Labs: ↓ Fibrinogen, monitor PT/PTT NIPE: Compress venipuncture site at least 30 min, bed rest during inf; give heparin to prevent reocclusion; in AMI, doses of >150 mg associated w/ intracranial bleeding Altretamine (Hexalen) [Antineoplastic/Alkylating Agent] WARNING: BM suppression, neurotox common Uses: *Epithelial ovarian CA* Action: Unknown; cytotoxic agent, unknown alkylating agent; ↓ nucleotide incorpo- ration into DNA/RNA Dose: 260 mg/m2/d in 4 ÷ doses for 14–21 d of a 28-d Rx cycle; 36 Aluminum Hydroxide dose ↑ to 150 mg/m2/d for 14 d in multiagent regimens (per protocols); after meals and at bedtime Caution: [D, ?/–]. Contra: Preexisting BM depression or neurologic tox Disp: Caps 50 mg SE: V/D, cramps; neurologic (peripheral neuropathy, CNS depression); minimally myelosuppressive Interactions: ↓ Effect W/ phenobarbital, ↓ antibody response W/ live virus vaccines, ↑ risk of tox W/ cimetidine & hypotension W/ MAOIs, ↑ BM depression W/ radiation Labs: Monitor CBC, ↑ alkaline phosphatase, BUN, SCr NIPE: Use barrier contraception, take w/ food, routine neuro exams Aluminum Hydroxide (Amphojel, AlternaGEL) [OTC] [Antacid/ Aluminum Salt] Uses: *Relief of heartburn, upset or sour stomach, or acid indigestion*; supl to Rx of hyperphosphatemia Action: Neutralizes gastric acid; –2 binds PO4 Dose: Adults. 10–30 mL or 300–1200 mg PO q4–6h. Peds. 5–15 mL PO q4–6h or 50–150 mg/kg/24 h PO ÷ q4–6h (hyperphosphatemia) Caution: [C, ?] Disp: Tabs 300, 600 mg; susp 320, 600 mg/5 mL SE: Constipation Interactions: ↓ Absorption & effects OF allopurinol, benzodiazepines, corticosteroids, chloroquine, cimetidine, digoxin, INH, phenytoin, quinolones, ranitidine, tetracycline Labs: ↑ Serum gastrin, ↓ serum phosphate NIPE: Separate other drug administration by 2 h, ↑ effectiveness of liquid form; OK in renal failure Aluminum Hydroxide + Magnesium Carbonate (Gaviscon Extra Strength, Liquid) [OTC] [Antacid/Aluminum & Magne- sium Salts] Uses: *Relief of heartburn, acid indigestion* Action: Neutralizes gastric acid Dose: Adults. 15–30 mL PO pc & hs. Peds. 5–15 mL PO qid or PRN; avoid in renal impair Caution: ↑ Mg2+ (w/ renal insuff) [C, ?] Disp: Liq w/ AlOH 95 mg/ MgCO3 358 mg/15 mL; Extra strength Liq AlOH 254 mg/Mg carbonate 237 mg/15mL; chew tabs AlOH 160 mg/MgCO3 105 mg SE: Constipation, D Interactions: In addition to AlOH ↓ effects OF histamine blockers, hydantoins, nitrofurantoin, phenothiazines, ticlopidine, ↑ effects OF quinidine, sulfonylureas NIPE: ↑ fiber; qid doses best given pc & hs; may affect absorption of some drugs, take 2–3 h apart to ↓ effect Aluminum Hydroxide + Magnesium Hydroxide (Maalox) [OTC] [Antacid/Aluminum & Magnesium Salts] Uses: *Hyper- acidity* (peptic ulcer, hiatal hernia, etc) Action: Neutralizes gastric acid Dose: Adults. 10–20 mL or 2–4 tabs PO qid or PRN. Peds. 5–15 mL PO qid or PRN Cau- tion: [C, ?] Disp: Tabs, susp SE: May cause ↑ Mg2+ in renal insuff, constipation, D Interactions: In addition to AlOH, ↓ effects OF digoxin, quinolines, phenytoin, Fe supl, & ketoconazole NIPE: N Concurrent drug use; separate by 2 h; doses qid best given pc & hs Aluminum Hydroxide + Magnesium Hydroxide & Sime- thicone (Mylanta, Mylanta II, Maalox Plus) [OTC] [Antacid/Aluminum & Magnesium Salts] Uses: *Hyperacidity w/ bloating* Action: Neutralizes gastric acid & defoaming Dose: Adults. 10–20 mL or 2–4 tabs PO qid or PRN Peds. 5–15 mL PO qid or PRN; avoid in renal impair Amikacin 37

Caution: [C, ?] Disp: Tabs, susp, Liq SE: ↑ Mg2+ in renal insuff, D, constipation Interactions: In addition to AlOH, ↓ effects OF digoxin, quinolones, phenytoin, Fe supl, and ketoconazole NIPE: N Concurrent drug use; separate by 2 h; Mylanta II contains 2 × AlOH & MgOH of Mylanta Aluminum Hydroxide + Magnesium Trisilicate (Gaviscon, Regular Strength) [OTC] [Antacid/Aluminum & Magnesium Salts] Uses: *Relief of heartburn, upset or sour stomach, or acid indigestion* Action: Neutralizes gastric acid Dose: Chew 2–4 tabs qid; avoid in renal impair Caution: [C, ?] Contra: Mg2+, sensitivity Disp: AlOH 80 mg/Mg trisilicate 20 mg/tab SE: ↑ Mg2+ in renal insuff, constipation, D Interactions: In addition to AlOH, ↓ effects OF digoxin, quinolines, phenytoin, Fe supl, & ketoconazole NIPE: N Concurrent drug use; separate by 2 h Amantadine (Symmetrel) [Antiviral, Antiparkinsonian/ AntiCholinergic-Like Medium] Uses: *Rx or prophylaxis influenza A, parkinsonism, & drug-induced EPS* (Note: Do not use for Influenza A in the US—increased resistance.) Action: Prevents release of infectious viral nucleic acid into host cell; releases dopamine from intact dopaminergic terminals Dose: Adults. Influenza A: 200 mg/d PO or 100 mg PO bid. Parkinsonism: 100 mg PO daily-bid. Peds. 1–9 y: 4.4–8.8 mg/kg/24 h to 150 mg/24 h max ÷ doses daily-bid. 10–12 y: 100–200 mg/d in 1–2 ÷ doses; ↓ in renal impair Caution: [C, M] Disp: Caps 100 mg; tabs 100 mg; soln 50 mg/5 mL SE: Orthostatic ↓ BP, edema, insomnia, depression, irritability, hallucinations, dream abnormalities; Interactions: ↑ Effects W/ HCTZ, triamterene, amiloride, pheasant’s eye herb, scopolia root, benztropine Labs: ↑ BUN, SCr, CPK, alkaline phosphatase, bilirubin, LDH, AST, ALT NIPE: N Dis- continue abruptly, take at least 4 h before sleep if insomnia occurs, eval for mental status changes, take w/ meals, N EtOH Amifostine (Ethyol) [Antineoplastic/Thiophosphate Cyto- protective] Uses: *Xerostomia prophylaxis during RT (head, neck, ovarian, non–small-cell lung CA); ↓ renal tox w/ repeated cisplatin* Action: Prodrug, de- phosphorylated by alkaline phosphatase to active thiol metabolite Dose: 910 mg/m2/d 15-min IV inf 30 min prior to chemo Caution: [C, +/–] CV disease Disp: 500-mg vials powder, reconstitute in NS SE: Transient ↓ BP (>60%), N/V, flushing w/ hot or cold chills, dizziness, ↓ Ca2+, somnolence, sneezing Notes: Does not ↓ effectiveness of cyclophosphamide + cisplatin chemo Interactions: ↑ Effects W/ antihypertensives Labs: ↓ Ca levels NIPE: Monitor BP, ensure adequate hydration, infuse over 15 min w/ pt supine Amikacin (Amikin) [Antibiotic/Aminoglycoside] Uses: *Seri- ous gram(-) bacterial Infxns* & mycobacteria Action: Aminoglycoside; ↓ protein synth Spectrum: Good gram(–) bacterial coverage: Pseudomonas & Mycobac- terium sp Dose: Adults & Peds. Conventional: 5–7.5 mg/kg/dose q8h; once daily; 15–20 mg/kg q24h; ↑ interval w/ renal impair. Neonates <1200 g, 0–4 wk: 7.5 mg/kg/dose q12–18h. Postnatal age <7 d, 1200–2000 g: 7.5 mg/kg/dose q12h; 38 Amiloride

>2000 g: 10 mg/kg/dose q12h. Postnatal age >7 d, 1200–2000 g: 7 mg/kg/dose q8h; >2000 g: 7.5–10 mg/kg/dose q8h Caution: [C, +/–] Avoid w/ diuretics Disp: 50 mg/mL, 250 mg/mL SE: Nephro/oto/neurotox, neuromuscular blockage, resp paralysis Notes: May be effective in gram(-) bacteria resistant to gent & tobra; follow Cr; Levels: Peak 30 min after inf; Trough <0.5h before next dose; Therapeutic: Peak 20–30 μg/mL, Trough <8 μg/mL; Toxic Peak >35 μg/mL; 1/2 life: 2 h Inter- actions: ↑ Risk OF ototox and nephrotox W/ acyclovir, amphotericin B, cephalosporins, cisplatin, loop diuretics, methoxyflurane, polymyxin B, vancomycin; ↑ neuromuscular blocking effect W/ muscle relaxants & anesthetics Labs: ↑ BUN, SCr, AST, ALT, serum alkaline phosphatase, bilirubin, LDH NIPE: ↑ Fluid consumption. Amiloride (Midamor) [Potassium Sparing Diuretic] Uses: *HTN, CHF, & thiazide-induced ↓ K+* Action: K+-sparing diuretic; interferes w/ K+/Na+ exchange in distal tubule Dose: Adults. 5–10 mg PO daily Peds. 0.625 mg/kg/d; ↓ in renal impair Caution: [B, ?] Contra: ↑ K+, SCr >1.5, BUN >30, diabetic neuropathy Disp: Tabs 5 mg SE: ↑ K+; HA, dizziness, dehydration, impotence Interactions: ↑ Risk of hyperkalemia W/ ACE-I, K-sparing diuretics, NSAIDs, & K salt substitutes; ↑ effects OF Li, digoxin, antihypertensives, amantadine; ↑ risk of hypokalemia W/ licorice Labs: monitor K+ NIPE: Take w/ food, I&O, daily wt, N salt substitutes, bananas, oranges Aminocaproic Acid (Amicar) [Antithrombotic Agent/ Carboxylic acid derivative] Uses: *Excessive bleeding from systemic hyperfibrinolysis & urinary fibrinolysis* Action: ↓ Fibrinolysis; via inhibition of TPA substances Dose: Adults. 5 g IV or PO (1st h) followed by 1–1.25 g/h IV or PO (max dose/d: 30 g) Peds. 100 mg/kg IV (1st h) then 1 g/m2/h; max 18 g/m2/d; ↓ in renal failure Caution: [C, ?] Upper urinary tract bleeding Contra: DIC Disp: Tabs 500, syrup 250 mg/mL, inj 250 mg/mL SE: ↓ BP, bradycardia, dizziness, HA, fatigue, rash, GI disturbance, ↓ plt Fxn Notes: Administer × 8 h or until bleeding controlled; not for upper urinary tract bleeding Interactions: ↑ Coagulation W/ estrogens & OCP Labs: ↑ K+ levels, false ↑ urine amino acids NIPE: Creatine kinase monitoring w/ long-term use, eval for thrombophlebitis & difficulty urinating Amino-Cerv pH 5.5 Cream [Cervical Hydrating Agent] Uses: *Mild cervicitis*, postpartum cervicitis/cervical tears, postcauterization, postcryosurgery, postconization Action: Hydrating agent; removes excess keratin in hyperkeratotic conditions Dose: 1 Applicatorful intravag hs × 2–4 wk Caution: [C, ?] w/ viral skin Infxn Disp: Vaginal cream SE: Stinging, local irritation NIPE: AKA carbamide or urea; contains 8.34% urea, 0.5% sodium propionate, 0.83% methionine, 0.35% cystine, 0.83% inositol, benzalkonium chloride Aminoglutethimide (Cytadren) [Adrenal Steroid Inhibitor] Uses: *Cushing synd* adrenocortical carcinoma, breast CA & CAP Action: ↓ Adrenal steroidogenesis & conversion of androgens to estrogens; aromatase inhibitor Dose: Initial 250 mg PO 4 × d, titrate q1–2wks max 2 g/d; w/ hydrocortisone Amiodarone 39

20–40 mg/d; ↓ in renal insuff Caution: [D, ?] Disp: Tabs 250 mg SE: Adrenal insuff (“medical adrenalectomy”), hypothyroidism, masculinization, ↓ BP, V, rare hepatotox, rash, myalgia, fever Interactions: ↓ Effects W/ dexamethasone & hydrocortisone, ↓ effects OF warfarin, theophylline, medroxyprogesterone NIPE: Masculinization reversible after D/C drug, N PRG Aminophylline [Bronchodilator/Xanthine Derivative] Uses: *Asthma, COPD* & bronchospasm Action: Relaxes smooth muscle (bronchi, pulm vessels); stimulates diaphragm Dose: Adults. Acute asthma: Load 6 mg/kg IV, then 0.4–0.9 mg/kg/h IV cont inf. Chronic asthma: 24 mg/kg/24 h PO ÷ q6h. Peds. Load 6 mg/kg IV, then 1 mg/kg/h IV cont inf; ↓ in hepatic insuff & w/ certain drugs (macrolide & quinolone antibiotics, cimetidine, & propranolol) Caution: [C, +] Uncontrolled arrhythmias, HTN, Sz disorder, hyperthyroidism, peptic ulcers Disp: Tabs 100, 200 mg; PR tabs 100, 200 mg, soln 105 mg/5 mL, inj 25 mg/mL SE: N/V, irritability, tachycardia, ventricular arrhythmias, Szs Notes: Individualize dosage; Level 10–20 μg/mL, tox >20 μg/mL; aminophylline 85% theophylline; erratic rectal absorption Interactions:↓ Effects OF Li, phenytoin, adenosine; ↓ effects W/ phenobarbital, aminoglutethamide, barbiturates, rifampin, ritonavir, thyroid meds; ↑ effects W/ cimetidine, ciprofloxacin, erythromycin, INH, OCP, verapamil, tobacco, charcoal-broiled foods, St. John’s Wort Labs:↑ Uric acid levels, falsely ↑ levels W/ furosemide, probenecid, acetaminophen, coffee, tea, cola, chocolate NIPE: N Chew or crush time-released caps & take on empty stomach, immediate release can be taken w/ food, ↑ fluids 2 L/d, tobacco ↑ drug elimination Amiodarone (Cordarone, Pacerone) [Ventricular Antiar- rhythmic/Adrenergic Blocker] Uses: *Recurrent VF or hemodynami- cally unstable VT*, supraventricular arrhythmias, AF Action: Class III antiarrhythmic (Table 10) Dose: Adults. Ventricular arrhythmias: IV: 15 mg/min for 10 min, then 1 mg/min ×6 h, maint 0.5 mg/min cont inf or PO: Load: 800–1600 mg/d PO ×1–3 wk. Maint: 600–800 mg/d PO for 1 mo, then 200–400 mg/d. Supraventricular arrhythmias: IV: 300 mg IV over 1 h, then 20 mg/kg for 24 h, then 600 mg PO daily for 1 wk, maint 100–400 mg daily or PO: Load: 600–800 mg/d PO for 1–4 wk. Maint: Slow ↓ to 100–400 mg daily (ECC 2005). Cardiac arrest: 300 mg IV push; 150 mg IV push 3–5 min PRN. Refractory pulseless VT, VF: 5 mg/kg rapid IV bolus. Perfusing arrhythmias: Load: 5 mg/kg IV/IO over 20–60 min (repeat, max 15 mg/kg/d). Peds. 10–15 mg/kg/24 h ÷ q12h PO for 7–10 d, then 5 mg/kg/24 h ÷ q12h or daily (infants/neonates require ↑ loading); ↓ w/ liver insuff Caution: [D, –] Contra: Sinus node dysfunction, 2nd-/3rd-degree AV block, sinus bradycardia (w/o pacemaker), iodine sensitivity Disp: Tabs 100, 200, 300, 400 mg; inj 50 mg/mL SE: Pulm fibrosis, exacerbation of arrhythmias, prolongs QT interval; CHF, hypo/hyperthyroidism, liver failure, corneal microdeposits, optic neuropathy/ neuritis, peripheral neuropathy, photosens Notes: IV conc of >0.2 mg/mL via a central catheter; Levels: Trough: Just before next dose Therapeutic: 1–2.5 μg/mL; Toxic: >2.5 μg/mL; 1/2 life: 30–100 h Interactions: ↑ Serum levels OF digoxin, 40 Amitriptyline quinidine, procainamide, flecainide, phenytoin, warfarin, theophylline, cyclosporine; ↑ levels W/ cimetidine, indinavir, ritonavir; ↓ levels W/ cholestyramine, ↑ ↑ ↑ rifampin, St. John’s Wort; cardiac effects W/ BBs, CCB Labs: LFTs, T4 & ↓ RT3, ANA titer, T3 NIPE: Monitor cardiac rhythm, BP, LFTs, thyroid Fxn, oph- thalmologic exam; ↑ photosensitivity—use sunscreen; take w/ food Amitriptyline (Elavil) [Antidepressant/TCA] WARNING: Antide- pressants may ↑ suicide risk; consider risks/benefits of use. Monitor patients closely Uses: *Depression*, peripheral neuropathy, chronic pain, tension HAs Action: TCA; ↓ reuptake of serotonin & norepinephrine by presynaptic neurons Dose: Adults. Initial, 30–50 mg PO hs; may ↑ to 300 mg hs. Peds. Not OK <12 y unless for chronic pain; initial 0.1 mg/kg PO hs, ↑ over 2–3 wk to 0.5–2 mg/kg PO hs; taper to D/C Caution: [D,+/–] CV Dz, seizures, NAG, hepatic impair Contra: w/ MAOIs, during acute MI recovery Disp: Tabs 10, 25, 50, 75, 100, 150 mg; inj 10 mg/mL SE: Strong anticholinergic SEs; OD may be fatal; urine retention, sedation, ECG changes, photosens Notes: Levels: Therapeutic: 120–150 ng/mL; Toxic: >500 mg/mL Interactions: ↓ Effects W/ carbamazepine, phenobarbital, rifampin, cholestyramine, colestipol, tobacco; ↑ effects W/ cimetidine, quinidine, indinavir, ritonavir, CNS depressants, SSRIs, haloperidol, OCPs, BBs, phenothiazines, EtOH, evening primrose oil; ↑ effects OF amphetamines, anticholinergics, epinephrine, hypoglycemics, phenylephrine Labs: ↑ Glucose, false ↑ carbamazepine levels NIPE: ↑ Photosensitivity—use sunscreen, appetite, & craving for sweets, N D/C abruptly, may turn urine blue-green Amlodipine (Norvasc) [Antihypertensive, Antianginal/CCB] Uses: *HTN, stable or unstable angina* Action: CCB; relaxes coronary vascular smooth muscle Dose: 2.5–10 mg/d PO; ↓ w/ hepatic impair Caution: [C, ?] Disp: Tabs 2.5, 5, 10 mg SE: Peripheral edema, HA, palpitations, flushing Interactions: ↑ Effect OF hypotension W/ antihypertensives, fentanyl, nirates quinidine, EtOH, grapefruit juice; ↑ risk OF neurotox W/ lithium; ↓ effects W/ NSAIDs Labs: Mon- itor BUN, Cr, LFTs NIPE: Take w/o regard to meals Amlodipine/Atorvastatin (Caduet) [Antianginal, Antihyper- tensive, Antilipemic/CCB, HMG-CoA Reductase Inhibitor] Uses: *HTN, chronic stable/vasospastic angina, control cholesterol & triglycerides* Action: CCB & HMG-CoA reductase inhibitor Dose: Amlodipine 2.5–10 mg w/ Atorvastatin 10–80 mg PO daily Caution: [X, –] Contra: Active liver Dz, ↑ LFT Disp: Tabs Amlodipine/Atorvastatin: 2.5/10, 2.5/20, 2.5/40, 5/10, 5/20, 5/40, 5/80, 10/10, 10/20, 10/40, 10/80 mg SE: Peripheral edema, HA, palpitations, flushing, myopathy, arthralgia, myalgia, GI upset Interactions: ↑ Hypotension W/ fentanyl, nitrates, EtOH, quinidine, other antihypertensives, grapefruit juice; ↑ effects W/ diltiazem, erythromycin, H2 blockers, proton pump inhibitors, quinidine; ↓ effects W/ NSAIDs, barbiturates, rifampin Labs: Monitor LFTs and CPK NIPE: N D/C abruptly, ↑ photosensitivity—use sunscreen; rare risk of rhabdomyolysis; instruct patient to report muscle pain/weakness Amphotericin B 41

Ammonium Aluminum Sulfate [Alum] [OTC] [GU Astringent] Uses: *Hemorrhagic cystitis when saline bladder irrigation fails* Action: Astrin- gent Dose: 1–2% soln w/ constant NS bladder irrigation Caution: [+/–] Disp: Powder for recons SE: Encephalopathy possible; can precipitate & occlude catheters Labs: Monitor aluminum levels, especially in renal insuff NIPE: Safe to use w/o anesthesia & w/ vesicoureteral reflux Amoxicillin (Amoxil, Polymox) [Antibiotic/Aminopenicillin] Uses: *Ear, nose, & throat, lower resp, skin, UTI from susceptible gram(+) bacteria* endocarditis prophylaxis Action: β-Lactam antibiotic; ↓ cell wall synth Spec- trum: Gram(+) (Streptococcus sp, Enterococcus sp); some gram(–) (H. influenzae, E. coli, N. gonorrhoeae, H. pylori, & P. mirabilis) Dose: Adults. 250–500 mg PO tid or 500–875 mg bid. Peds. 25–100 mg/kg/24 h PO ÷ q8h. 200–400 mg PO bid (equivalent to 125–250 mg tid); ↓ in renal impair Caution: [B, +] Disp: Caps 250, 500 mg; chew tabs 125, 200, 250, 400 mg; susp 50 mg/mL, 125, 200, 250, 400 mg/5 mL; tabs 500, 875 mg SE: D; skin rash Interactions: ↑ Effects OF warfarin, ↑ effects W/ probenecid, disulfiram, ↑ risk of rash W/ allopurinol, ↓ effects OF OCP, ↓ effects W/ tetracyclines, chloramphenicol Labs: ↑ Serum alkaline phosphatase, LDH, LFTs, false + direct Coombs test NIPE: Space med over 24 h, eval for super Infxn, use barrier contraception; cross hypersensitivity w/ PCN; many E. coli strains resistant; chew tabs contain pheylalanine Amoxicillin & Clavulanic Acid (Augmentin, Augmentin 600 ES, Augmentin XR) [Antibiotic/Aminopenicillin, Beta-lactamase Inhibitor] Uses: *Ear, lower resp, sinus, UTI, skin Infxns caused by β-lactamase- producing H. influenzae, S. aureus, & E. coli* Action: Combo β-lactam antibiotic & β-lactamase inhibitor. Spectrum: Gram(+) same as amox alone, MSSA; gram(–) as w/ amox alone, β-lactamase-producing H. influenzae, Klebsiella sp, M. catarrhalis Dose: Adults. 250–500 mg PO q8h or 875 mg q12h; XR 2000 mg PO q12h. Peds. 20–40 mg/kg/d as amoxicillin PO ÷ q8h or 45 mg/kg/d ÷ q12h; ↓ in renal impair; take w/ food Caution: [B, enters breast milk] Disp: Supplied (as amox/clav): Tabs 250/125, 500/125, 875/125 mg; chew tabs 125/31.25, 200/28.5, 250/62.5, 400/57 mg; susp 125/31.25, 250/62.5, 200/28.5, 400/57 mg/5 mL; susp: ES 600/42.9 mg/5 mL; XR tab 1000/62.5 mg SE: Abd discomfort, N/V/D, allergic Rxn, vaginitis Notes: Do not substitute two 250-mg tabs for one 500-mg tab (OD of clavulanic acid); max clavulanic acid 125 mg/dose Interactions: ↑ Effects OF warfarin, ↑ effects W/ probenecid, disulfiram, ↑ risk of rash W/ allopurinol, ↓ effects OF OCP, ↓ effects W/ tetracyclines, chloramphenicol Labs: ↑ Serum alkaline phosphatase, LDH, LFTs, false + direct Coombs test NIPE: Space med over 24/h, eval for super Infxn, use barrier contraception Amphotericin B (Amphocin) [Antifungal/Polyene Macrolide] Uses: *Severe, systemic fungal Infxns; oral & cutaneous candidiasis* Action: Binds ergosterol in the fungal membrane to alter permeability Dose: Adults & Peds. Test dose: 1 mg IV adults or 0.1 mg/kg to 1 mg IV in children; then 0.25–1.5 mg/kg/24 h IV 42 Amphotericin B Cholesteryl over 2–6 h (range 25–50 mg/d or qod). Total dose varies w/ indication. PO: 1 mL qid Caution: [B, ?] Disp: Powder for inj 50 mg/vial SE: ↓ K+/Mg2+ from renal wasting; anaphylaxis reported, HA, fever, chills, nephrotox, ↓ BP, anemia, rigors Notes: ? ↓ In renal impair; pretreatment w/ APAP & antihistamines (Benadryl) ↓ SE Interactions: ↑ Nephrotoxic effects W/ antineoplastics, cyclosporine, furosemide, vancomycin, aminoglycosides, ↑ hypokalemia W/ corticosteroids, skeletal muscle relaxants Labs: Monitor Cr/LFTs/K/Mg; ↑ serum bilirubin, serum cholesterol NIPE: Monitor CNS effects & N take hs Amphotericin B Cholesteryl (Amphotec) [Antifungal/Polyene Macrolide] Uses: *Aspergillosis if intolerant/refractory to conventional amphotericin B*, systemic candidiasis Action: Binds cell membrane sterols, alters permeability Dose: Adults & Peds. Test dose 1.6–8.3 mg, over 15–20 min, then 3–4 mg/kg/d; 1 mg/kg/h inf; ↓ w/ renal insuff Caution: [B, ?] Disp: Powder for inj 50 mg, 100 mg/vial SE: Anaphylaxis; fever, chills, HA, nephrotox, ↓ BP, anemia Notes: Do not use in-line filter Interactions: See Amphotericin B Labs: Monitor LFTs, electrolytes; ↓ K+, ↓ Mg2+ Amphotericin B Lipid Complex (Abelcet) [Antifungal/Polyene Macrolide] Uses: *Refractory invasive fungal Infxn in pts intolerant to conventional ampho B* Action: Binds cell membrane sterols, alters permeability Dose: Adults & Peds. 5 mg/kg/d IV single daily dose; 2.5 mg/kg/h inf Caution: [B, ?] Disp: Inj 5 mg/mL SE: Anaphylaxis; fever, chills, HA, nephrotox, ↓ BP, anemia Notes: Filter w/ 5-μm needle; do not mix in electrolyte-containing solns; if inf >2 h, manually mix bag Interactions: See Amphotericin B Labs: ↓ K+, ↓ Mg2+ Amphotericin B Liposomal (AmBisome) [Antifungal/Poly- ene Macrolide] Uses: *Refractory invasive fungal Infxn w/ intolerance to conventional ampho B; cryptococcal meningitis in HIV; empiric for febrile neutropenia; visceral leishmaniasis* Action: Binds cell membrane sterols, changes membrane permeability Dose: Adults & Peds. 3–6 mg/kg/d, inf 60–120 min; Caution: [B, ?] Disp: Powder inj 50 mg SE: Anaphylaxis, fever, chills, HA, nephrotox, ↓ BP, anemia Notes: Use no less than 1- μm filter; ? ↓ in renal insuff Interactions: See Amphotericin B Labs: ↓ K+, ↓ Mg2+ Ampicillin (Amcill, Omnipen) [Antibiotic/Aminopenicillin] Uses: *Resp, GU, or GI tract Infxns, meningitis due to gram(-) & (+) bacteria; SBE prophylaxis* Action: β-Lactam antibiotic; ↓ cell wall synth. Spectrum: Gram(+) (Streptococcus sp, Staphylococcus sp, Listeria sp); gram(–) (Klebsiella sp, E. coli, H. influenzae, P. mirabilis, Shigella sp, Salmonella sp) Dose: Adults. 500 mg–2 g IM or IV q6h or 250–500 mg PO q6h. Peds. Neonates <7 d: 50–100 mg/kg/24 h IV ÷ q8h. Term infants: 75–150 mg/kg/24 h ÷ q6–8h IV or PO. Chil- dren >1 mo: 100–200 mg/kg/24 h ÷ q4–6h IM or IV; 50–100 mg/kg/24 h ÷ q6h PO up to 250 mg/dose. Meningitis: 200–400 mg/kg/24 h ÷ q4–6h IV; ↓ in renal impair; take on empty stomach Caution: [B, M] Cross hypersensitivity w/ PCN Disp: Caps 250, 500 mg; susp 100 mg/mL (reconstituted drops), 125 mg/5 mL, Anakinra 43

250 mg/5 mL; powder for inj 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g/vial SE: D, skin rash, allergic Rxn Notes: Many E. coli strains resistant Interactions: ↓ Effects OF OCP & atenolol, ↓ effects W/ chloramphenicol, erythromycin, tetracycline, & food; ↑ effects OF anticoagulants & MTX; ↑ risk of rash W/ allopurinal; ↑ effects W/ probenecid & disulfiram Labs: ↑ LFTs, serum protein, serum theophylline, serum uric acid; ↓ serum estrogen, serum cholesterol, serum folate; false + direct Coombs test, urine glucose, & urine amino acids NIPE: Take on empty stomach & around the clock; may cause candidal vaginitis; use barrier contraception Ampicillin-Sulbactam (Unasyn) [Antibiotic/Aminopenicillin & Beta-Lactamase Inhibitor] Uses: *Gynecologic, intra-abd, skin Infxns due to β-lactamase-producing S. aureus, Enterococcus sp, H. influenzae, P. mirabilis, & Bacteroides sp* Action: β-lactam antibiotic & β-lactamase inhibitor. Spectrum: Gram(+) & (–) as for amp alone; also Enterobacter, Acinetobacter, Bac- teroides Dose: Adults. 1.5–3 g IM or IV q6h. Peds. 100–200 mg ampicillin/kg/d (150–300 mg Unasyn) q6h; ↓ w/ renal insuff Caution: [B, M] Disp: Powder for inj 1.5, 3 g/vial, 15 g bulk package SE: Allergic Rxns, rash, D, inj site pain Notes: A 2:1 ratio Ampicillin:Sulbactam Interactions: See Ampicillin Amprenavir (Agenerase) [Antiviral/HIV Protease Inhibitor] WARNING: PO soln contra in children <4 y, Asians, Eskimos, Native Americans (polypropylene glycol tox) Uses: *HIV Infxn* Action: Protease inhibitor; prevents virion maturation Dose: Adults. 1200 mg bid. Peds. 20 mg/kg bid or 15 mg/kg tid to 2400 mg/d; ↓ w/ hepatic insuff Caution: [C, ?] CDC recommends HIV-infected mothers not to breast-feed; h/o sulfonamide allergy Contra: CYP450 3A4 substrates (Table 11); soln <4 y, PRG, hepatic/renal insuff, w/ disulfiram, metronidazole Disp: Caps 50, 150 mg; soln 15 mg/mL SE: Life-threatening rash, hyperglycemia, hypertriglyceridemia, fat redistribution, N/V/D, depression Notes: Caps & soln contain vitamin E > RDA; Interactions: ↑ Effects W/ abacavir, cimetidine, delavirdine, indinavir, itraconazole, ketoconazole, macrolides, ritonavir, zidovudine, grapefruit juice; ↑ effects OF cisapride, clozapine, ergotamine, loratadine, nelfinavir, dapsone, pimozide, rifabutin, saquinavir, sildenafil, terfenadine, triazolam, warfarin, zidovudine, HMG-CoA reductase inhibitors; ↓ effects W/ antacids, barbiturates, carbamazepine, nevirapine, phenytoin, rifampin, St. John’s Wort, high-fat food; ↓ effects OF OCP Labs: ↑ Serum glucose, cholesterol, & triglyceride levels NIPE: Use barrier contraception, may take w/ food other than high-fat food, N take vitamin E Anakinra (Kineret) [Antirheumatic/Immunomodulator] WARNING: Associated w/ ↑ incidence of serious Infxn; D/C w/ serious Infxn Uses: *Reduce S/Sxs of moderate/severe active RA, failed 1 or more DMARD* Action: Human IL-1 receptor antagonist Dose: 100 mg SQ daily; w/ CrCl <30 mL/min, QOD Caution: [B, ?] Contra: E. coli–derived proteins allergy, active Infxn, <18 y Disp: 100-mg prefilled syringes; 100 mg (0.67 mL/vial) SE: Neutrope- nia especially w/ TNF-blocking agents, inj site Rxn, Infxn Interactions: ↓ Effects 44 Anastrozole

OF immunizations; ↑ risk of Infxns if combined W/ TNF-blocking drugs Labs: ↓ WBCs, plts, absolute neutrophil count NIPE: Store drug in refrigerator, N light exposure, & discard unused portion; N use soln if discolored or has particulate matter Anastrozole (Arimidex) [Antineoplastic/Nonsteroidal Aro- matase Inhibitor] Uses: *Breast CA: postmenopausal w/ met breast CA, adjuvant Rx postmenopausal early hormone-receptor(+) breast CA* Action: Se- lective nonsteroidal aromatase inhibitor, ↓ circ estradiol Dose: 1 mg/d Caution: [D, ?] Contra: PRG Disp: Tabs 1 mg SE: D, HTN, flushing, ↑ bone/tumor pain, HA, somnolence Interactions: None noted Labs: ↑ GTT, LFTs, alkaline phosphatase, total & LDL cholesterol; No effect on adrenal corticosteroids or aldosterone NIPE: May ↓ fertility & cause fetal damage, eval for pain & administer adequate analgesia, may cause vaginal bleeding first few weeks Anidulafungin (Eraxis) [Antifungal/Echinocandin] Uses: *Candidemia, esophageal candidiasis, other Candida sp Infxn (peritonitis, intra- abd abscess)* Action: Echinocandin; ↓ cell wall synth. Spectrum: C. albicans, C. glabrata, C. parapsilosis, C. tropicalis Dose: Candidemia, others: 200 mg IV × 1, then 100 mg IV daily (Tx 14 d after last + culture); Esophageal candidiasis: 100 mg IV × 1, then 50 mg IV daily (Tx >14 d and 7 d after resoln of Sx); 1.1 mg/min max inf rate Caution: [C, ?/–] Contra: Echinocandin hypersensitivity Disp: Powder 50 mg/vial, 100 mg/vial SE: Generally safe, histamine-mediated inf Rxns (urticaria, flushing, ↓ BP, dyspnea, etc), fever, N/V/D, HA, hepatitis, worsening hepatic failure Labs: ↑ LFTs, ↓ K+ NIPE: ↓ Inf rate to <1.1 mg/min w/ inf Rxns Anistreplase (Eminase) [Antithrombotic Agent/Plasminogen Activator] Uses: *AMI* Action: Thrombolytic; activates conversion of plasminogen to plasmin, ↑ thrombolysis Dose: 30 units IV over 2–5 min (ECC 2005) Caution: [C, ?] Contra: Active internal bleeding, h/o CVA, recent (<2 mo) intracranial or intraspinal surgery/trauma/neoplasm, AVM, aneurysm, bleeding diathesis, severe HTN Disp: 30 units/vial SE: Bleeding, ↓ BP, hematoma Notes: Ineffective if readministered >5 d after the previous dose of anistreplase or streptokinase, or streptococcal Infxn (production of antistreptokinase Ab) Interactions: ↑ Risk of hemorrhage W/ warfarin, oral anticoagulants, ASA, NSAIDs, dipyridamole; ↓ effectiveness W/ aminocaproic acid Labs: ↓ Plasminogen & fibrinogen, ↑ transaminase level, thrombin time, aPTT & PT NIPE: Store powder in refrigerator & use w/in 30 min of reconstitution, initiate therapy ASAP after MI, monitor S/Sxs internal bleeding Anthralin (Anthra-Derm) [Keratolytic Dermatologic Agent] Uses: *Psoriasis* Action: Keratolytic Dose: Apply daily Caution: [C, ?] Contra: Acutely inflamed psoriatic eruptions, erythroderma Disp: Cream, oint 0.1, 0.25, 0.4, 0.5, 1% SE: Irritation; hair/fingernails/skin discoloration Interactions: ↑ Tox if used immediately after long-term topical corticosteroid therapy NIPE: May stain fabric; external use only; N sunlight-medicated areas Aprepitant 45

Antihemophilic Factor [AHF, Factor VIII] (Monoclate) [Anti- hemophilic] Uses: *Classic hemophilia A, von Willebrand Dz* Action: Pro- vides factor VIII needed to convert prothrombin to thrombin Dose: Adults & Peds. 1 AHF unit/kg ↑ factor VIII level @2%, units required = (kg) (desired factor VIII ↑ as % nl) × (0.5); Prevent spontaneous hemorrhage = 5% nl; Hemostasis after trauma/surgery = 30% nl; Head injuries, major surgery, or bleeding = 80–100% nl Caution: [C, ?] Disp: Each vial for units contained, powder for recons SE: Rash, fever, HA, chills, N/V Notes: Determine % nl factor VIII before dosing In- teractions: None Labs: Monitor CBC & direct Coombs test NIPE: N ASA, immunize against Hep B, DC if tachycardic Antithymocyte Globulin (See Lymphocyte Immune Globulin,) [Im- munosuppressive Agent] Apomorphine (Apokyn) [Antiparkinsonian/Dopamine Ago- nist] WARNING: Do not administer IV Uses: *Acute, intermittent hypomobility (“off”) episodes of Parkinson Dz* Action: Dopamine agonist Dose: Adults. 0.2-mL SQ test dose under medical supervision; if BP OK, initial 0.2 mL (2 mg) SQ during “off” periods; only 1 dose per “off” period; titrate dose; 0.6 mL (6 mg) max single doses; use w/ antiemetic; ↓ in renal impair Caution: [C, +/–] Avoid EtOH; antihypertensives, vasodilators, cardio or cerebrovascular Dz, hepatic impair Contra: 5HT3 antagonists, sulfite allergy Disp: Inj 10 mg/mL, 3-mL pen cartridges; 2-mL amp SE: Emesis, syncope, QT prolongation, orthostatic ↓ BP, somnolence, ischemia, injection site Rxn, abuse potential, dyskinesia, fibrotic conditions, priapism Interac- tions:↑ Risk of hypotension W/ alosetron, dolasetron, granisetron, ondansetron, palonosetron Labs: ECG—monitor for prolongation of QT interval NIPE: Daytime somnolence may limit activities; trimethobenzamide 300 mg tid PO or other non–5HT3 antagonist antiemetic given 3 d prior to & up to 2 mo following initiation Apraclonidine (Iopidine) [Glaucoma Agent/Alpha-Adrenergic α Agonist] Uses: *Glaucoma, postop intraocular HTN* Action: 2-Adrenergic agonist Dose: 1–2 gtt of 0.5% tid; 1 gtt before and after surgical procedure Cau- tion: [C, ?] Contra: w/ MAOI Disp: 0.5, 1% soln SE: Ocular irritation, lethargy, xerostomia Interactions: ↓ Intraocular pressure W/ pilocarpine or topical BBs NIPE: Monitor CV status of pts w/ CAD, potential for dizziness Aprepitant (Emend) [Centrally Acting Antiemetic] Uses *Pre- vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics)* Action: Substance P/neurokinin 1(NK1) receptor antagonist Dose: 125 mg PO day 1, 1 h before chemo, then 80 mg PO q AM days 2 & 3 Caution: [B, ?/–]; substrate & mod CYP3A4 inhibitor; CYP2C9 inducer (Table 11) Contra: Use w/ pimozide, Disp: Caps 40, 80, 125 mg SE: Fatigue, asthenia, hiccups Interactions: ↑ Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin; ↑ effects OF alprazolam, astemizole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfenadine, triazolam & chemotherapeutic agents, eg, docetaxel, etoposide, ifosfamide, imatinib, 46 Aprotinin irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine; ↓ effects W/ paroxetine, rifampin; ↓ effects OF OCPs, paroxetine, phenytoin, tolbutamide, warfarin Labs: ↑ ALT, AST, BUN, alkaline phosphatase, leukocytes NIPE: Use barrier contraception, take w/o regard to food Aprotinin (Trasylol) [Antithrombotic Agent/Protease Inhibitor] WARNING: May cause fatal anaphylactic Rxns Uses: *↓ Loss during CABG* Action: Protease inhib, antifibrinolytic Dose: 1-mL IV test dose; High dose: 2 million KIU load, 2 million KIU to prime pump, then 500,000 KIU/h until surgery ends; Low dose: 1 million KIU load, 1 million KIU to prime pump, then 250,000 KIU/h until surgery ends; 7 million KIU max total Caution: [B, ?] Thromboembolic Dz requiring anticoagulants/blood factor administration Contra: Previous use <12 mo (↑ anaphylactic risk) Disp: Inj 1.4 mg/mL (10,000 KIU/mL) SE: AF, MI, CHF, dyspnea, Notes: 1000/KIU = 0.14 mg aprotinin Interactions: ↑ Clotting time W/ heparin, ↓ effects OF fibrinolytics, captopril Labs: Monitor aPTT, ACT, CBC, BUN, Cr; postop ↑ Cr NIPE: Monitor cardiac and pulmonary status during inf Arformoterol (Brovana) [Long acting Beta 2 agonist] WARNING: Long-acting β-2 agonists may ↑ risk of asthma related death Uses: *COPD maint* Action: LA β-2 agonist, relaxes airway smooth muscles Dose: 15 μg neb bid, 30 μg/d max Caution: [C, ?] w/ CV disease, ↓ Contra: Not for acute asthma; component hypersensitivity; peds; w/ phenothiazines Disp: 15 μg/2 mL nebulizer SE: chest/back pain, D, sinusitis, leg cramps, dyspnea, rash, flu-synd, ↑ BP, arrhythmias, heart block ↓K+ Argatroban (Acova) [Anticoagulant/Thrombin inhibitor] Uses: *Prevent/Tx thrombosis in HIT, PCI in pts w/ risk of HIT* Action: Antico- agulant, direct thrombin inhibitor Dose: 2 μg/kg/min IV; adjust until aPTT 1.5–3 × baseline not to exceed 100 s; 10 μg/kg/min max; ↓ w/ hepatic impair Caution: [B, ?] Avoid PO anticoagulants, ↑ bleeding risk; avoid use w/ thrombolytics Contra: Overt major bleed Disp: Inj 100 mg/mL SE: AF, cardiac arrest, cerebrovascular disorder, ↓ BP, VT, N/V/D, sepsis, cough, renal tox, Note: Steady state in 1–3 h Interactions: ↑ Risk of bleeding W/ anticoagulants, feverfew, garlic, ginger, ginkgo, ↑ risk of intracranial bleed W/ thrombolytics Labs: ↑ aPTT, PT, INR, ACT, thrombin time; ↓ Hgb NIPE: Report ↑ bruising & bleeding, N breast-feed Aripiprazole (Abilify) [Antipsychotic/Psychotropic] WARNING: Increased mortality in elderly with dementia-related psychosis Uses: *Schizophre- nia* Action: Dopamine & serotonin antagonist Dose: Adults. 10–15 mg PO daily; 5.25–15 mg for acute agitation ↓ dose W/ CYP3A4/CYP2D6 inhibitors (Table 11); ↑ dose W/ CYP3A4 inducer Caution: [C, –] Disp: Tabs 2, 5, 10, 15, 20, 30 mg; Discmelt (disint. tabs 10, 15, 20, 30 mg, soln 1 mg/mL, inj 7.5 mg/mL SE: Neu- roleptic malignant synd, tardive dyskinesia, orthostatic ↓ BP, cognitive & motor impair Interactions: ↑ Effects W/ ketoconazole, quinidine, fluoxetine, paroxetine, ↓ effects W/ carbamazepine Labs: ↑ Glucose NIPE: N Breast-feed, consume EtOH, or use during PRG; use barrier contraception; ↑ fluid intake Aspirin & Butalbital Compound 47

Artificial Tears (Tears Naturale) [OTC] [Ocular Lubricant] Uses: *Dry eyes* Action: Ocular lubricant Dose: 1–2 gtt tid-qid Disp: OTC soln l-Asparaginase (Elspar, Oncaspar) [Antineoplastic/Protein Synthesis Inhibitor] Uses: *ALL* (in combo w/ other agents) Action: Protein synth inhibitor Dose: 500–20,000 IU/m2 /d for 1–14 d (Per protocols) Cau- tion: [C, ?] Contra: Active/h/o pancreatitis Disp: Inj powder for recons 10,000 units SE: Allergy 20–35% (urticaria to anaphylaxis); rare GI tox (mild N, anorexia, pancreatitis) ↑ glucose, coagulopathy; Interactions: ↑ Effects W/ prednisone, vincristine; ↓ effects OF MTX, sulfonylureas, insulin Labs: Monitor glucose & pt/plt; ↓ ↑ T4 & T4-binding globulin, serum albumin, total cholesterol, plasma fibrinogen; BUN, glucose, uric acid, LFTs, alkaline phosphatase NIPE: ↑ Fluid intake, monitor for bleeding, monitor I&O and wt, N EtOH or ASA; test dose recommended Aspirin (Bayer, Ecotrin, St. Joseph’s) [OTC] [Antipyretic, Analgesic/Salicylate] Uses: *Angina, CABG, PTCA, carotid endarterec- tomy, ischemic stroke, TIA, MI, arthritis, pain,* HA, *fever*, inflammation, Kawasaki Dz Action: Prostaglandin inhibitor Dose: Adults. Pain, fever: 325–650 mg q4–6h PO or PR. RA: 3–6 g/d PO in ÷ doses. Plt inhibitor: 81–325 mg PO daily. Prevent MI: 81(preferred)–325 mg PO daily. Acute Coronary Syndrome (ECC 2005): 160–325 mg PO ASAP (chewing preferred at onset) Peds. An- tipyretic: 10–15 mg/kg/dose PO or PR q4h up to 80 mg/kg/24 h. RA: 60–100 mg/kg/24 h PO ÷ q4–6h (keep levels 15–30 mg/dL); avoid w/ CrCl <10 mL/min, severe liver Dz Caution: [C, M] Linked to Reye synd; avoid w/ viral illness in children Contra: Allergy to ASA, chickenpox/flu Sxs, synd of nasal polyps, angioedema, & bronchospasm to NSAIDs Disp: Tabs 325, 500 mg; chew tabs 81 mg; EC tabs 81, 162, 325, 500, 650, 975 mg; SR tabs 650, 800 mg; effervescent tabs 325, 500 mg; supp 125, 200, 300, 600 mg SE: GI upset & erosion Notes: Salicy- late levels Therapeutic: 100–250 μg/mL. Toxic: >300 μg/mL Interactions: ↑ Ef- fects W/ anticoagulants, ammonium chloride, antibiotics, ascorbic acid, furosemide, methionine, nizatidine, NSAIDs, verapamil, EtOH, feverfew, garlic, ginkgo biloba, horse chestnut, kelpware (black-tang), prickly ash, red clover; ↓ effects W/ antacids, ↑ activated charcoal, corticosteroids, griseofulvin, NaHCO3, ginseng, food; effects OF ACEI, hypoglycemics, insulin, Li, MTX, phenytoin, sulfonamides, valproic acid; ↓ effects OF BBs, probenecid, spironolactone, sulfinpyrazone Labs: False- results of urinary glucose & urinary ketone tests, serum albumin, total serum phenytoin, T3 & T4 NIPE: D/C 1 wk prior to surgery; avoid/limit EtOH; Chronic ASA use may result in ↓ folic acid, Fe-deficiency anemia, & hypernatremia; N foods ↑ salicylate, eg curry powder, paprika, licorice, prunes, raisins, tea; take ASA w/ food or milk; report S/Sxs bleeding/GI pain/ringing in ears Aspirin & Butalbital Compound (Fiorinal) [C-III] [Analgesic & Barbiturate] Uses: *Tension HA*, pain Action: Combo barbiturate & analgesic Dose: 1–2 PO q4h PRN, max 6 tabs/d; avoid w/ CrCl <10 mL/min & severe liver Dz Caution: [C (D w/ prolonged use or high doses at term), ?] Contra: 48 Aspirin + Butalbital, Caffeine, & Codeine

ASA allergy, GI ulceration, bleeding disorder, porphyria, synd of nasal polyps, angioedema, & bronchospasm to NSAIDs Disp: Caps (Fiorgen PF, Lanorinal), Tabs (Lanorinal) ASA 325 mg/butalbital 50 mg/caffeine 40 mg SE: Drowsiness, dizziness, GI upset, ulceration, bleeding; see Aspirin Additional Interactions: ↑ Ef- fect OF benzodiazepines, CNS depressants, chloramphenicol, methylphenidate, propoxyphene, valproic acid; ↓ effects OF BBs, corticosteroids, chloramphenicol, cyclosporines, doxycycline, griseofulvin, haloperidol, OCPs, phenothiazines, quinidine, TCAs, theophylline, warfarin NIPE: Butalbital habit-forming; D/C 1 wk prior to surgery, use barrier contraception, N EtOH Aspirin + Butalbital, Caffeine, & Codeine (Fiorinal + Codeine) [C-III] [Analgesic & Barbiturate & Narcotic] Uses: Mild *pain,* HA, especially when associated w/ stress Action: Sedative analgesic, narcotic analgesic Dose: 1–2 tabs (caps) PO q4–6h PRN max 6/d Caution: [D, ?] Contra: Allergy to ASA and codeine; synd of nasal polyps, angioedema, & bronchospasm to NSAIDs Disp: Cap/tab contains 325 mg ASA, 40 mg caffeine, 50 mg of butalbital, 30 mg of codeine SE: Drowsiness, dizziness, GI upset, ulceration, bleeding; see Aspirin + Butalbital Additional Interactions: ↑ Effects W/ narcotic analgesics, MAOIs, neuromuscular blockers, ↓ effects W/ tobacco smoking; ↑ effects OF digitoxin, phenytoin, rifampin; ↑ resp & CNS depression W/ cimetidine Labs: ↑ Plasma amylase & lipase NIPE: D/C 1 wk prior to surgery, avoid/limit EtOH; May cause constipation, ↑ fluids & fiber, take w/ milk to ↓ GI distress Aspirin + Codeine (Empirin No. 3, 4) [C-III] [Narcotic Anal- gesic] Uses: Mild to *moderate pain* Action: Combined effects of ASA & codeine Dose: Adults. 1–2 tabs PO q4–6h PRN. Peds. ASA 10 mg/kg/dose; codeine 0.5–1 mg/kg/dose q4h Caution: [D, M] Contra: Allergy to ASA/codeine, PUD, bleeding, anticoagulant Rx, children w/ chickenpox or flu Sxs, synd of nasal polyps, angioedema, & bronchospasm to NSAIDs Disp: Tabs 325 mg of ASA & codeine (Codeine in No. 3=30 mg, No. 4=60 mg) SE: Drowsiness, dizziness, GI upset, ulceration, bleeding; see Aspirin Additional Interactions ↑ Effects W/ narcotic analgesics, MAOIs, neuromuscular blockers, ↓ effects W/ tobacco smoking; ↑ effects OF digitoxin, phenytoin, rifampin; ↑ resp & CNS depression W/ cimetidine Labs: ↑ Plasma amylase & lipase NIPE: D/C 1 wk prior to surgery; avoid/limit EtOH; May cause constipation, ↑ fluids & fiber, take w/ milk to ↓ GI distress Atazanavir (Reyataz) [Antiretroviral/HIV-1 Protease In- hibitor] WARNING: Hyperbilirubinemia may require drug D/C Uses: *HIV-1 Infxn* Action: Protease inhibitor Dose: 400 mg PO daily w/ food; when given w/ efavirenz 600 mg, administer atazanavir 300 mg + ritonavir 100 mg once/d; separate doses from buffered didanosine administration; ↓ in hepatic impair Caution: [B, –]; Contra: w/ midazolam, triazolam, ergots, pimozide Disp: Caps 100, 150, 200, 300 mg SE: HA, N/V/D, rash, abd pain, DM, photosens, ↑ PR interval Notes: May have less adverse effect on cholesterol Interactions: ↑ Effects W/ amprenavir, clarithromycin, indinavir, lamivudine, lopinavir, ritonavir, saquinavir, stavudine, Atomoxetine 49 tenofovir, zalcitabine, zidovudine; ↑ effects OF amiodarone, atorvastatin, CCBs, clarithromycin, cyclosporine, diltiazem, irinotecan, lidocaine, lovastatin, OCPs, rifabutin, quinidine, saquinavir, sildenafil, simvastatin, sirolimus, tacrolimus, TCAs, ↓ warfarin; effects W/ antacids, antimycobacterials, efavirenz, esomeprazole, H2 receptor antagonists, lansoprazole, omeprazole, rifampin, St. John’s Wort Labs: ↑ ALT, AST, total bilirubin, amylase, lipase, serum glucose, ↓ Hgb, neutrophils NIPE: CDC recommends HIV-infected mothers not to breast-feed; take w/ food; will not cure HIV or ↓ risk of transmission; use barrier contraception; ↑ risk of skin and/or scleral yellowing Atenolol (Tenormin) [Antihypertensive, Antianginal/Beta- Blocker] Uses: *HTN, angina, MI* Action: β-Adrenergic receptor blocker Dose: HTN & angina: 50–100 mg/d PO. AMI: 5 mg IV × 2 over 10 min, then 50 mg PO bid if tolerated; ↓ in renal impair; 5 mg IV over 5 min; in 10 min, 5 mg slow IV; if tolerated in 10 min, start 50 mg PO, then 50 mg PO BID (ECC 2005) Cau- tion: [D, M] DM, bronchospasm; abrupt D/C can exacerbate angina & ↑ MI risk Contra: Bradycardia, cardiogenic shock, cardiac failure, 2nd-/3rd-degree AV block Disp: Tabs 25, 50, 100 mg; inj 5 mg/10 mL SE: Bradycardia, ↓ BP, 2nd-/ 3rd-degree AV block, dizziness, fatigue Interactions: ↑ Effects W/ other antihypertensives especially diltiazem & verapamil, nitrates, EtOH; ↑ bradycardia W/ adenosine, digitalis glycosides, dipyridamole, physostigmine, tacrine; ↓ effects W/ ampicillin, antacids, NSAIDs, salicylates; ↑ effects OF lidocaine; ↓ effects OF dopamine, glucagons, insulin, sulfonylureas Labs: ↑ ANA titers, BUN, glucose, serum lipoprotein, K+, triglyceride, uric acid levels; ↓ HDL NIPE: May mask S/Sxs hypoglycemia, may ↑ sensitivity to cold, may ↑ depression, wheezing, orthostatic hypotension Atenolol & Chlorthalidone (Tenoretic) [Antihypertensive, Antianginal/Beta-Blocker & Diuretic] Uses: *HTN* Action: β- Adrenergic blockade w/ diuretic Dose: 50–100 mg/d PO; ↓ in renal impair Cau- tion: [D, M] DM, bronchospasm Contra: See Atenolol; anuria, sulfonamide cross-sensitivity Disp: Tenoretic 50: Atenolol 50 mg/chlorthalidone 25 mg; Tenoretic 100: Atenolol 100 mg/chlorthalidone 25 mg SE: Bradycardia, ↓ BP, 2nd- or 3rd-degree AV block, dizziness, fatigue; see Atenolol Additional Interactions: ↑ Effects W/ other antihypertensives; ↓ effects W/ cholestyramine, NSAIDs; ↑ effects OF Li, digoxin, ↓ effects OF sulfonylureas Labs: False ↓ urine esriol; ↑ CPK, serum ammonia, amylase, Ca2+, Cl-, K+, cholesterol, glucose; ↓ serum Cl-, Mg2+, K+, Na– NIPE: Take in AM to prevent nocturia, use sunblock >SPF 15, photosensitivity, monitor S/Sxs gout Atomoxetine (Strattera) [ADHD/Selective Norepinephrine Reuptake Inhibitor] WARNING: Severe liver injury may rarely occur; D/C w/ jaundice or ↑LFT, ↑ frequency of suicidal thoughts Uses: *ADHD* Ac- tion: Selective norepinephrine reuptake inhibitor Dose: Adults & children >70 kg. 40 mg × 3 d, ↑ to 80–100 mg ÷ daily-bid. Peds <70 kg. 0.5 mg/kg × 3 d, then 50 Atorvastatin

↑ 1.2 mg/kg daily or bid (max 1.4 mg/kg or 100 mg) Caution: [C, ?/–] Contra: NAG, w/ or w/in 2 wk of D/C an MAOI Disp: Caps 5, 10, 18, 25, 40, 60, 80, 100 mg SE: ↑ BP, tachycardia, wt loss, sexual dysfunction NIPE: ↓ Dose w/ hepatic insuff or in combo w/ CYP2D6 inhibitors (Table 11) Atorvastatin (Lipitor) [Antilipemic/HMG-CoA Reductase In- hibitor] Uses: *↑ Cholesterol & triglycerides* Action: HMG-CoA reductase inhibitor Dose: Initial 10 mg/d, may ↑ to 80 mg/d Caution: [X, –] Contra: Active liver Dz, unexplained ↑ LFT Disp: Tabs 10, 20, 40, 80 mg SE: Myopathy, HA, arthralgia, myalgia, GI upset; Interactions: ↑ Effects W/ azole antifungals, erythromycin, nefazodone, protease inhibitors, grapefruit juice; ↓ effects W/ antacids, bile acid sequestrants; ↑ effects OF digoxin, levothyroxine, OCPs Labs: Monitor LFTs due to ↑ LFTs, CPK, ↓ lipid levels NIPE: Instruct patient to report unusual muscle pain or weakness; N EtOH, breast-feeding, or while PRG Atovaquone (Mepron) [Antiprotozoal] Uses: *Rx & prevention PCP* Action: ↓ nucleic acid & ATP synth Dose: Rx: 750 mg PO bid for 21 d. Pre- vention: 1500 mg PO once/d (w/ meals) Caution: [C, ?] Disp: Susp 750 mg/5 mL SE: Fever, HA, anxiety, insomnia, rash, N/V Interactions: ↓ Effects W/ metoclopramide, rifabutin, rifampin, tetracycline Labs: Monitor LFTs w/ long-term use NIPE: ↑ Absorption w/ meal esp ↑ fat Atovaquone/Proguanil (Malarone) [Antimalarial] Uses: *Pre- vention or Rx P. falciparum malaria* Action: Antimalarial Dose: Adults: Preven- tion: 1 tab PO 2 d before, during, & 7 d after leaving endemic region; Rx: 4 tabs PO single dose daily × 3 d. Peds. See insert Caution: [C, ?] Contra: CrCl <30 mL/min Disp: Tab atovaquone 250 mg/proguanil 100 mg; peds 62.5/25 mg SE: HA, fever, myalgia Interactions: ↓ Effects W/ metoclopramide, rifabutin, rifampin, tetracycline Labs: Monitor LFTs w/ long-term use NIPE: ↑ Absorption w/ meal esp ↑ fat Atracurium (Tracrium) [Skeletal Muscle Relaxant/Neuro- muscular Blocker] Uses: *Anesthesia adjunct to facilitate ET intubation* Action: Nondepolarizing neuromuscular blocker Dose: Adults & Peds. 0.4–0.5 mg/kg IV bolus, then 0.08–0.1 mg/kg q20–45 min PRN Caution: [C, ?] Disp: Inj 10 mg/mL SE: Flushing Notes: Pt must be intubated & on controlled ventilation; use adequate amounts of sedation & analgesia; Interactions: ↑ Effects W/ general anesthetics, aminoglycosides, bacitracin, BBs, β-agonists, clindamycin, CCBs, diuretics, lidocaine, Li, MgSO4, narcotic analgesics, procainamide, quinidine, succinylcholine, trimethaphan, verapamil; ↓ effects W/ Ca, carbamazepine, phenytoin, theophylline, caffeine Labs: Monitor BUN, Cr, LFTs NIPE: Drug does not effect consciousness or pain, inability to speak until drug wears off Atropine (AtroPen) [Antiarrhythmic/Anticholinergic] WARN- ING: Primary protection against exposure to chemical nerve agent and insecticide poisoning is the wearing of specially designed protective garments Uses: *Preanes- thetic; symptomatic bradycardia & asystole, organophosphate (insecticide) and acetylcholinesterase (nerve gas) inhibitor antidote; cycloplegic* Action: Antimuscarinic; Atropine/pralidoxime 51 blocks acetylcholine at parasympathetic sites, cycloplegic Dose: Adults. (2005 ECC): Asystole or PEA: 1 mg IV/IO push. Repeat every 3–5 min (if asystole persists) to 0.03–0.04 mg/kg max. Bradycardia: 0.5–1.0 mg IV every 3–5 min as needed; max 0.03–0.04 mg/kg; ET 2–3 mg in 10 mL NS. Preanesthetic: 0.3–0.6 mg IM. Poisoning: 1–2 mg IV bolus, repeat Q 3–5 min PRN to reverse effects Peds. (ECC 2005): 0.01–0.03 mg/kg IV q2–5min, max 1 mg, min dose 0.1 mg. Preanes- thetic: 0.01 mg/kg/dose SC/IV (max 0.4 mg). Poisoning: 0.05 mg/kg IV, repeat Q 3–5 min PRN to reverse effects Caution: [C, +] Contra: NAG Disp: inj 0.05, 0.1, 0.3, 0.4, 0.5, 0.8, 1 mg/mL; AtroPen AutoInjector: 0.5, 1, 2 mg/dose; MDI 0.36 mg/inhal SE: Flushing, mydriasis, tachycardia, dry mouth & nose, blurred vision, urinary retention, constipation, psychosis Notes: SLUDGE (salivation, lacrimation, urination, diaphoresis, gastrointestinal motility, emesis) are Sx of organophosphate poisoning; AutoInjector limited distribution Interactions: ↑ Effects W/ amantadine, antihistamines, disopyramide, procainamide, quinidine, TCA, thiazides, betel palm, squaw vine; ↓ effects W/ antacids, levodopa; ↓ effects OF phenothiazines Labs: ↓ Gastric motility & emptying may affect results of upper GI series NIPE: Monitor I&O, ↑ fluids & oral hygiene, wear dark glasses to ↓ photophobia Atropine, ophthalmic (Isopto Atropine, generic) [Antiar- rhythmic/Anticholinergic] Uses: *Cycloplegic refraction, uveitis, ambly- opia * Action: Antimuscarinic; cycloplegic, dilates pupils Dose: Adults. Refraction: 1–2 gtt 1 h before; Uveitis: 1–2 gtt daily-qid Peds. 1 gtt in nonamblyotic eye daily Caution: [C, +] Contra: Glaucoma Disp: 15-mL bottle 1% ophthal soln SE: Local irritation, burning, blurred vision, light sensitivity; Interactions: ↑ Effects W/ amantadine, antihistamines, disopyramide, procainamide, quinidine, TCA, thiazides, betel palm, squaw vine; ↓ effects W/ antacids, levodopa; ↓ effects OF phenothiazines NIPE: Compress lacrimal sac 2–3 min after instillation; effects can last 1–2 weeks; increased risk of photophobia Atropine/pralidoxime (DuoDote) [Antiarrhythmic/Anticholin- ergic/Antidote] WARNING: For use by personnel with appropriate training; wear protective garments; do not rely solely on medication; evacuation and decontamination as soon as possible Uses: *Nerve agent and insecticide poisoning* Action: Atropine blocks effects of excess acetylcholine; pralidoxime reactivates acetylcholinesterase inactivated by organophosphorus poisoning Dose: 1 injection in midlateral thigh; if symptoms progress or are severe, give 2 additional injections Caution: [C, ?] Contra: Disp: AutoInjector 2.1 mg atropine/60 mg pralidoxime SE: Dry mouth, blurred vision, dry eyes, photophobia, confusion, HA, tachycardia, flushing, urinary retention, constipation, abd pain N/V, emesis Interactions: ↑ Ef- fects W/ amantadine, antihistamines, disopyramide, procainamide, quinidine, TCA, thiazides, betel palm, squaw vine; ↑ effects OF barbiturates; ↓ effects W/ antacids, levodopa; ↓ effects OF phenothiazines Labs: ↑ ALT, AST, Cr NIPE: Severe Sx of poisoning include confusion, dyspnea with copious secretions, weakness & twitching, involuntary urination and defecation, convulsions, unconsciousness 52 Azathioprine

Azathioprine (Imuran) [Immunosuppressant/Purine Antag- onist] WARNING: May ↑ neoplasia w/ chronic use; mutagenic and hematologic tox possible Uses: *Adjunct to prevent renal transplant rejection, RA*, SLE, Crohn Dz, ulcerative colitis Action: Immunosuppressive; antagonizes purine metabolism Dose: Adults & Peds. 1–3 mg/kg/d IV or PO; Crohn and ulcerative colitis, start 50 mg/d, ↑ 100–250 mg/d; ↓ w/ renal insuff Caution: [D, ?] Contra: PRG Disp: Tabs 25, 50, 75, 100 mg; inj 100 mg powder for recons SE: GI intolerance, fever, chills, leukopenia, thrombocytopenia Interactions: ↑ Effects W/ allopurinol; ↑ effects OF antineoplastic drugs, cyclosporine, myelosuppressive drugs, MTX; ↑ risk OF severe leucopenia W/ ACEI; ↓ effects OF nondepolarizing neuromuscular blocking drugs, warfarin Labs: Monitor BUN, Cr, CBC, LFTs during therapy NIPE: Handle inj w/ cytotoxic precautions; do not administer live vaccines on drug; dose per local transplant protocol, usually start 1–3 d pretransplant N PRG, breast-feeding Azelastine (Astelin, Optivar) [Antihistamine/H1-Receptor Antagonist] Uses: *Allergic rhinitis (rhinorrhea, sneezing, nasal pruritus); allergic conjunctivitis* Action: Histamine H1-receptor antagonist Dose: Nasal: 2 sprays/nostril bid. Ophth: 1 gtt in each affected eye bid Caution: [C, ?/–] Contra: Component sensitivity Disp: Nasal 137 μg/spray; ophth soln 0.05% SE: Somnolence, bitter taste Interactions: ↑ Effects W/ cimetidine; ↑ effects OF EtOH, CNS depressants Labs: ↑ AST, ↓ skin reactions to antigen skin tests NIPE: Systemically absorbed; clear nares before admin; prime pump before use Azithromycin (Zithromax) [Antibiotic/Macrolide] Uses: *Community-acquired pneumonia, pharyngitis, otitis media, skin Infxns, nongonococcal (chlamydial) urethritis, chancroid & PID; Rx & prevention of MAC in HIV* Action: Macrolide antibiotic; bacteriostatic; ↓ protein synth. Spectrum: Chlamydia sp, H. ducreyi, H. influenzae, Legionella sp, M. catarrhalis, M. pneumoniae, M. hominis, N. gonorrhoeae, S. aureus, S. agalactiae, S. pneumoniae, S. pyogenes Dose: Adults. Resp tract Infxns: PO: Cap 500 mg day 1, then 250 mg/d PO × 4 d. Sinusitis 500 mg/d PO × 3 d. IV: 500 mg × 2 d, then 500 mg PO × 7–10 d or 500 mg IV daily × 2 d, then 500 mg/d PO × 7–10 d Nongonococcal urethritis: 1 g PO × 1. Gonorrhea, uncomplicated 2 mg PO × 1; Prevent MAC: 1200 mg PO once/wk. Peds. Otitis media: 10 mg/kg PO day 1, then 5 mg/kg/d days 2–5. Pharyngitis: 12 mg/kg/d PO × 5 d (susp on empty stomach; tabs OK w/ or w/o food; ↓ w/ CrCl <10 mL/mg Caution: [B, +] Disp: Tabs 250, 500, 600 mg; Z-Pack (5-d, 250 mg); Tri-Pak (500-mg tabs × 3); susp 1-g; single-dose packet (ZMAX) ER susp. (2 g); susp 100, 200 mg/5 mL; powder for recons 500, 2.5-mg ophtn soln 1% SE: GI upset, metallic taste Interactions: ↓ Effects W/ Al- & Mg-containing antacids, atovaquone, food (suspension); ↑ effects OF alfentanil, barbiturates, bromocriptine, carbamazepine, cyclosporine, digoxin, disopyramide, ergot alkaloids, phenytoin, pimozide, terfenadine, theophylline, triazolam, warfarin; ↓ effects OF penicillins Labs: May ↑ serum bilirubin, alkaline phosphatase, BUN, Cr, Baclofen 53

CPK, glucose, K+, LFTs, LDH, PT; may ↓ WBC, plt count, serum folate NIPE: Monitor S/Sxs super Infxns, use sunscreen & protective clothing Aztreonam (Azactam) [Antibiotic/Monobactam] Uses: *Aero- bic gram(-) UTIs, lower resp, intra-abd, skin, gynecologic Infxns & septicemia* Action: Monobactam. ↓ Cell wall synth. Spectrum: Gram(-) (Pseudomonas sp, E. coli, Klebsiella sp, H. influenzae, Serratia sp, Proteus sp, Enterobacter sp, Cit- robacter sp) Dose: Adults. 1–2 g IV/IM q6–12h. Peds. Premature: 30 mg/kg/dose IV q12h. Term & children: 30 mg/kg/dose q6–8h; ↓ in renal impair Caution: [B, +] Disp: Inj (soln), 1 g, 2 g/ 50 mL Inj powder for recons 500 mg 1 g, 2 g SE: N/V/D, rash, pain at injection site Interactions: ↑ Effects W/ probenecid, aminoglycosides, β-lactam antibiotics; ↓ effects W/ cefoxitin, chloramphenicol, imipenem Labs: ↑ LFTs, alkaline phosphatase, SCr, PT, PTT, & + direct Coombs test NIPE: No gram(+) or anaerobic activity; OK in PCN-allergic pts; Monitor S/Sxs super Infxn, taste changes w/ IV administration Bacitracin, Ophthalmic (AK-Tracin Ophthalmic); Bacitracin & Polymyxin B, Ophthalmic (AK Poly Bac Ophthalmic, Poly- sporin Ophthalmic); Bacitracin, Neomycin, & Polymyxin B, Ophthalmic (AK Spore Ophthalmic, Neosporin Ophthalmic); Bacitracin, Neomycin, Polymyxin B, & Hydrocortisone, Oph- thalmic (AK Spore HC Ophthalmic, Cortisporin Ophthalmic) [Antibiotic/Anti-Inflammatory] Uses: *Steroid-responsive inflammatory ocular conditions* Action: Topical antibiotic w/ anti-inflammatory Dose: Apply q3–4h into conjunctival sac Caution: [C, ?] Contra: Viral, mycobacterial, fungal eye Infxn Disp: See Bacitracin, Topical equivalents, below Interactions: ↑ Effects W/ neuromuscular blocking agents, anesthetics, nephrotoxic drugs NIPE: May cause blurred vision Bacitracin, Topical (Baciguent); Bacitracin & Polymyxin B, Topical (Polysporin); Bacitracin, Neomycin, & Polymyxin B, Topical (Neosporin Ointment); Bacitracin, Neomycin, Polymyxin B, & Hydrocortisone, Topical (Cortisporin); Bacitracin, Neomycin, Polymyxin B, & Lidocaine, Topical (Clomycin) [Antibiotic/Anti- Inflammatory/Analgesic] Uses: Prevent/Rx of *minor skin Infxns* Action: Topical antibiotic w/ added components (anti-inflammatory & analgesic) Dose: Apply sparingly bid-qid Caution: [C, ?] Disp: Bacitracin 500 units/g oint; Bacitracin 500 units/polymyxin B sulfate 10,000 units/g oint & powder; Bacitracin 400 units/neomycin 3.5 mg/polymyxin B 5000 units/g oint; Bacitracin 400 units/neomycin 3.5 mg/polymyxin B 10,000 units/hydrocortisone 10 mg/g oint; Bacitracin 500 units/ neomycin 3.5 mg/polymyxin B 5000 units/lidocaine 40 mg/g oint NIPE: Systemic & irrigation forms available, but not generally used due to potential tox Baclofen (Lioresal Intrathecal, generic) [Antispasmodic/ Skeletal Muscle Relaxant] WARNING: IT abrupt D/C can lead to organ failure, rhabdomyolysis, & death Uses: *Spasticity due to severe chronic 54 Balsalazide disorders (eg, MS, ALS, or spinal cord lesions)*, trigeminal neuralgia, hiccups Ac- tion: Centrally acting skeletal muscle relaxant; ↓ transmission of monosynaptic & polysynaptic cord reflexes Dose: Adults. Initial, 5 mg PO tid; ↑ q3d to effect; max 80 mg/d. Intrathecal: Via implantable pump (see insert) Peds. 2–7 y: 10–15 mg/d ÷ q8h; titrate, max 40 mg/d. >8 y: Max 60 mg/d. IT: Via implantable pump; ↓ in renal impair; w/ food or milk Caution: [C, +] Epilepsy, neuropsychiatric disturbances; Disp: Tabs 10, 20 mg; IT inj 50 μg/mL 10 mg/20 mL, 10 mg/5 mL SE: Dizziness, drowsiness, insomnia, ataxia, weakness, ↓ BP Interactions: ↑ CNS depression W/ CNS depressants, MAOIs, EtOH, antihistamines, opioid analgesics, sedatives, hypnotics; ↑ effects OF antihypertensives, clindamycin, guanabenz; ↑ risk of resp paralysis & renal failure W/ aminoglycosides Labs: ↑ Serum glucose, AST, ammonia, alkaline phosphatase; ↓ bilirubin NIPE: Take oral meds w/ food; N EtOH Balsalazide (Colazal) [Anti-inflammatory/GI Drug] Uses: *Ulcerative colitis* Action: 5-ASA derivative, anti-inflammatory, ↓ leukotriene synth Dose: 2.25 g (3 caps) tid × 8–12 wk Caution: [B, ?] Severe renal/hepatic failure Contra: Mesalamine or salicylates hypersensitivity Disp: Caps 750 mg SE: Dizziness, HA, N, agranulocytosis, pancytopenia, renal impair, allergic Rxns Notes: Daily dose of 6.75 g = to 2.4 g mesalamine Interactions: Oral antibiotics may interfere W/ mesalamine release in the colon Labs: ↑ Bilirubin, CPK, LFTs, LDH, NIPE: N If ASA allergy; take w/ food & swallow capsule whole Basiliximab (Simulect) [Immunosuppressant/Monoclonal Antibody] WARNING: Administer only under the supervision of a provider experienced in immunosuppression therapy in an appropriate facility Uses: *Pre- vent acute transplant rejection* Action: IL-2 receptor antagonists Dose: Adults. 20 mg IV 2 h before transplant, then 20 mg IV 4 d post. Peds. 12 mg/m2 ↑ to max of 20 mg 2 h prior to transplant; same dose IV 4 d post Caution: [B, ?/–] Avoid w/ other immunosuppressants Contra: Hypersensitivity to murine proteins Disp: Inj: powder for recons 10, 20 mg SE: Edema, HTN, HA, dizziness, fever, pain, Infxn, GI effects, electrolyte disturbances Notes: A murine/human MoAb Interactions: May ↑ immunosuppression W/ other immunosuppressive drugs Labs: ↑ Choles- terol, BUN, Cr, lipids, uric acid; ↓ serum Mg phosphate, plts, Hgb, Hct, Ca2+ , ↑ or ↓ glucose, K+; NIPE: Monitor for Infxns, hypersensitivity Rxns, IV dose over 20–30 min BCG [Bacillus Calmette-Guérin] (TheraCys, Tice BCG) [Anti- neoplastic, Antituberculotic] Uses: *Bladder carcinoma (superficial)*, TB prophylaxis Action: Immunomodulator Dose: Bladder CA, 1 vial prepared & instilled in bladder for 2 h. Repeat once/wk for 6 wk; then 1 treatment at 3, 6, 12, 18, & 24 mo after initial therapy Caution: [C, ?] Asthma Contra: Im- munosuppression, UTI, steroid use, acute illness, fever of unknown origin, w/ trau- matic catheterization or UTI Disp: Inj powder for recons 81 mg (10.5 ± 8.7 × 108 CFU vial) (TheraCys), 50 mg (1–8 × 108 CFU/vial) (Tice BCG) SE: Intravesical: Hematuria, urinary frequency, dysuria, bacterial UTI, rare BCG sepsis Notes: Routine Benazepril 55

US adult BCG immunization not rec; occasionally used in high-risk children who are PPD(-) & cannot take INH, dispose/void in toilet with chlorine bleach; Inter- actions: ↓ Effects W/ antimicrobials, immunosuppressives, radiation Labs: Prior BCG may cause false + PPD NIPE: Monitor for S/Sxs systemic Infxn, report persistent pain on urination or blood in urine Becaplermin (Regranex Gel) [Growth Factor] Uses: Adjunct to local wound care w/ *diabetic foot ulcers* Action: Recombinant PDGF, enhances granulation tissue Dose: Based on lesion; 11/3-in ribbon from 2-g tube, 2/3-in ribbon from 15-g tube/in × in2 of ulcer; apply & cover w/ moist gauze; rinse after 12 h; do not reapply; repeat in 12 h Caution: [C, ?] Contra: Neoplasm/or active site Infxn Disp: 0.01% gel in 2-, 15-g tubes SE: Erythema, local pain; Interactions: None known NIPE: Dosage recalculated q1–2 wk; Use w/ good wound care; wound must be vascularized Beclomethasone (Beconase) [Anti-inflammatory/Corticos- teroid] Uses: *Allergic rhinitis* refractory to antihistamines & decongestants; *nasal polyps* Action: Inhaled steroid Dose: Adults & Peds 6–12. Aqueous inhal: 1–2 sprays/nostril twice daily Caution: [C, ?] Disp: Nasal met-dose inhaler SE: Local irritation, burning, epistaxis Notes: Nasal spray delivers 42 μg/dose Interac- tions: None noted NIPE: Prior use of decongestant nasal gtt if edema or secretions, may take several days for full steroid effect Beclomethasone (QVAR) [Antiasthmatic/Synthetic Corticos- teroid] Uses: Chronic *asthma* Action: Inhaled corticosteroid Dose: Adults & Peds. 5–11 y: 40–160 μg 1–4 inhal bid; initial 40–80 μg inhal bid if on bronchodilators alone; 40–160 μg w/ other inhaled steroids; 320 μg bid max; taper to lowest effective dose bid rinse mouth/throat after Caution: [C, ?] Contra: Acute asthma Disp: PO met-dose inhaler; 40, 80 μg/inhal SE: HA, cough, hoarseness, oral candidiasis Notes: Not effective for acute asthma Interactions: None noted NIPE: Use inhaled bronchodilator prior to inhaled steroid, rinse mouth after inhaled steroid Belladonna & Opium Suppositories (B&O Supprettes) [C-II] [Antispasmodic, Analgesic] Uses: *Bladder spasms; moderate/severe pain* Action: Antispasmodic, analgesic Dose: 1 supp PR q6h PRN; 15A=30 mg powdered opium/16.2 mg belladonna extract; 16A=60 mg powdered opium/16.2 mg belladonna extract Caution: [C, ?] Contra: Glaucoma, resp dep Disp: Supp 15A, 16A SE: Anticholinergic (eg, sedation, urinary retention, constipation) Interac- tions: ↑ Effects W/ CNS depressants, TCAs; ↓ effects W/ phenothiazines Labs: ↑ LFTs NIPE: N Refrigerate; moisten finger & supp before insertion; may cause blurred vision Benazepril (Lotensin) [Antihypertensive/ACEI] Uses: *HTN*, DN, CHF Action: ACE inhibitor Dose: 10–40 mg/d PO Caution: [C (1st tri), D (2nd & 3rd tri), +] Contra: Angioedema, h/o edema, bilateral RAS Disp: Tabs 5, 10, 20, 40 mg SE: Symptomatic ↓ BP w/ diuretics; dizziness, HA, nonproductive 56 Benzocaine & Antipyrine cough Interactions: ↑ Effects W/ α-blockers, diuretics, capsaicin; ↓ effects W/ NSAIDs, ASA; ↑ effects OF insulin, Li; ↑ risk of hyperkalemia W/ trimethoprim & K-sparing diuretics Labs: ↑ BUN, SCr, K+; ↓ hemoglobin; ECG changes NIPE: Persistent cough and/or taste changes may develop; N PRG, D/C if angioedema Benzocaine & Antipyrine (Auralgan) [Otic Anesthetic] Uses: *Analgesia in severe otitis media* Action: Anesthetic w/ local decongestant Dose: Fill ear & insert a moist cotton plug; repeat 1–2 h PRN Caution: [C, ?] Contra: w/ perforated eardrum Disp: Soln 5.4% antipyrine, 1.4% benzocaine SE: Local irritation; Interactions: May ↓ effects OF sulfonamides Benzonatate (Tessalon Perles) [Antitussive] Uses: Symptomatic relief of *cough* Action: Anesthetizes the stretch receptors in the resp passages Dose: Adults & Peds. >10 y: 100 mg PO tid (max 600 mg/d) Caution: [C, ?] Disp: Caps 100, 200 mg SE: Sedation, dizziness, GI upset Interactions: ↑ CNS depression W/ antihistamines, EtOH, hypnotics, opioids, sedatives NIPE: ↑ Fluid intake to liquefy secretions; Do not chew or puncture the caps Benztropine (Cogentin) [Antiparkinsonian/Anticholinergic] Uses: *Parkinsonism & drug-induced extrapyramidal disorders* Action: Partially blocks striatal cholinergic receptors Dose: Adults. 0.5–6 mg PO, IM, or IV in ÷ doses/d to 4 mg/day max Peds. >3 y: 0.02–0.05 mg/kg/dose 1–2/d Caution: [C, ?] Contra: <3 y, myasthenia gravis Disp: Tabs 0.5, 1, 2 mg; inj 1 mg/mL SE: Anti- cholinergic side effects Notes: Physostigmine 1–2 mg SC/IV to reverse severe Sxs Interactions: ↑ Sedation and depressant effects W/ EtOH & CNS depressants; ↑ anticholinergic effects W/ antihistamines, phenothiazines, quinidine, disopyramide, TCAs, MAOIs; ↑ effect OF digoxin; ↓ effect OF levodopa; ↓ effects W/ antacids and antidiarrheal drugs NIPE: May ↑ susceptibility to heat stroke, take w/ meals to avoid GI upset Beractant (Survanta) [Lung Surfactant] Uses: *Prevention & Rx of RDS in premature infants* Action: Replaces pulm surfactant Dose: 100 mg/kg via ET tube; repeat 3 × q6h PRN; max 4 doses/48 h Disp: Susp 25 mg of phospholipid/mL SE: Transient bradycardia, desaturation, apnea Notes: Administer via 4- quadrant method Interactions: None noted NIPE: ↑ Risk of nosocomial sepsis after Rx w/ this drug Betaxolol (Kerlone) [Antihypertensive/Beta-Blocker] Uses: β β *HTN* Action: Competitively blocks -adrenergic receptors, 1 Caution: [C (1st tri), D (2nd or 3rd tri), +/–] Contra: Sinus bradycardia, AV conduction abnormalities, uncompensated cardiac failure Dose: 5–20 mg/d Disp: Tabs 10, 20 mg SE: Dizzi- ness, HA, bradycardia, edema, CHF Interactions: ↑ Effects W/ anticholinergics, verapamil, general anesthetics; ↓ effects W/ thyroid drugs, amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine, NSAIDs; ↑ effects OF insulin, digitalis glycosides; ↓ effects OF theophylline, dopamine, glucagon Labs: ↑ BUN, serum lipoprotein, glucose, K+, triglyceride, uric acid, ANA titers NIPE: May ↑ sensitivity to cold, N D/C abruptly Bisacodyl 57

Betaxolol, Ophthalmic (Betoptic) [Beta-Blocker] Uses: Open- β β angle glaucoma Action: Competitively blocks -adrenergic receptors, 1 Dose: 1–2 gtt bid Caution: [C (1st tri), D (2nd or 3rd tri), ?/–] Disp: Soln 0.5%; susp 0.25% SE: Local irritation, photophobia; see Betaxolol + NIPE: Use sunglasses to ↓ exposure, may cause photophobia, review installation procedures Bethanechol (Urecholine, Duvoid, others) [Urinary Tract Stimulant/Cholinergic Agonist] Uses: *Neurogenic bladder atony w/ retention*, acute *postop* & postpartum functional *(nonobst) urinary retention* Action: Stimulates cholinergic smooth muscle receptors in bladder & GI tract Dose: Adults. 10–50 mg PO tid-qid or 2.5–5 mg SQ tid-qid & PRN. Peds. 0.6 mg/kg/24 h PO ÷ tid-qid or 0.15–2 mg/kg/d SQ ÷ 3–4 × (take on empty stomach) Caution: [C, ?/–] Contra: BOO, PUD, epilepsy, hyperthyroidism, bradycardia, COPD, AV conduction defects, parkinsonism, ↓ BP, vasomotor instability Disp: Tabs 5, 10, 25, 50 mg; inj 5 mg/mL SE: Abd cramps, D, salivation, ↓BP Notes: Do not use IM/IV Interactions: ↑ Effects W/ BBs, tacrine, cholinesterase inhibitors; ↓ effects W/ atropine, anticholinergic drugs, procainamide, quinidine, epinephrine Labs: ↑ In serum AST, ALT, amylase, lipase, bilirubin NIPE: May cause blurred vision, monitor I&O, take on an empty stomach Bevacizumab (Avastin) [Antineoplastic/Monoclonal Anti- body] WARNING: Associated w/ GI perforation, wound dehiscence, & fatal hemoptysis Uses: *Met colorectal ca, w/ 5-FU NSCLC w/ paclitaxel and carboplatin* Action: Vascular endothelial GF inhibitor Dose: Adults. Colon: 5 mg/kg or 10 mg/kg IV q14d; NSCLC: 15 mg/kg q21d; 1st dose over 90 min; 2nd over 60 min, 3rd over 30 min if tolerated Caution: [C, –] Do not use w/in 28 d of surgery if time for separation of drug & anticipated surgical procedures is unknown; D/C w/ serious adverse events Disp: 100 mg/4 mL, 400 mg/16 mL vials SE: Wound dehiscence, GI perforation, tracheoespohageal fistula, hemoptysis, hemorrhage, HTN, proteinuria, CHF, inf Rxns, D, leucopenia, thromboembolism Labs: Monitor for ↑ proteinuria; NIPE: Monitor for ↑ BP Bicalutamide (Casodex) [Antineoplastic/Nonsteroidal An- tiandrogen] Uses: *Advanced CAP (met)* (w/ GnRH agonists [eg, leuprolide, goserelin]) Action: Nonsteroidal antiandrogen Dose: 50 mg/d Caution: [X, ?] Contra: Women Disp: Caps 50 mg SE: Hot flashes, loss of libido, impotence, D/N/V, gynecomastia Interactions: ↑ Effects OF anticoagulants, TCAs, phenothiazides; ↓ effects OF antipsychotic drugs Labs: ↑ LFTs, alkaline phosphatase, bilirubin, BUN, Cr; ↓ Hgb, WBCs NIPE: Monitor PSA, may experience hair loss Bicarbonate (See Sodium Bicarbonate) Bisacodyl (Dulcolax) [OTC] [Stimulant Laxative] Uses: *Consti- pation; preop bowel prep* Action: Stimulates peristalsis Dose: Adults. 5–15 mg PO or 10 mg PR PRN. Peds. <2y: 5 mg PR PRN. >2 y: 5 mg PO or 10 mg PR PRN (do not chew tabs or give w/in 1 h of antacids or milk) Caution: [B, ?] Con- tra: Acute abdomen or bowel obst, appendicitis, gastroenteritis Disp: EC tabs 5 mg; 58 Bismuth Subcitrate/Metronidazole/Tetracycline

DR tab 5 mg; supp 10 mg, enema soln 10 mg/30 mL SE: Abd cramps, proctitis, & inflammation w/ suppositories Interactions: Antacids & milk ↑ dissolution OF EC causing abd irritation Labs: ↑ Phosphate, Na; ↓ Ca, Mg, K+ NIPE: ↑ Fluid intake & high-fiber foods, N take w/ milk or antacids Bismuth Subcitrate/Metronidazole/Tetracycline (Pylera) [Antibacterial/Antiprotozoal] WARNING: Metronidazole carcinogenic in mice and rats; avoid use unless absolutely necessary. Uses: *H. pylori Infxn w/ omeprazole* Action: eradication of H. pylori, Dose: 3 caps 4 × d w/ omeprazole 20 mg 2× d for 10 d Caution: [D, –] Contra: Pregnancy, childhood to 8 yr (tetracycline during tooth development causes teeth discoloration), w/ renal/hepatic impair, component hypersensitivity Disp: Caps w/ 140 mg bismuth subcitrate potassium, 125 mg metronidazole, and 125 mg tetracycline hydrochloride SE: Stool abnormality, D, dyspepsia, abd pain, HA, flu-like synd, taste perversion, vaginitis, dizziness; see SE for each component Interactions: See multiple drug interactions for each component Labs: ↓ neutrophils, WBC; NIPE: EtOH use may cause disulfiram-like reaction; possible occurrence of metallic taste & reddish- brown urine; take with food. Bismuth Subsalicylate (Pepto-Bismol) [Antidiarrheal/ Adsorbent] [OTC] Uses: Indigestion, N, & *D*; combo for Rx of *H. pylori Infxn* Action: Antisecretory & anti-inflammatory Dose: Adults. 2 tabs or 30 mL PO PRN (max 8 doses/24 h). Peds. 3–6 y: 1/3 tab or 5 mL PO PRN (max 8 doses/24 h). 6–9 y: 2/3 tab or 10 mL PO PRN (max 8 doses/24 h). 9–12 y: 1 tab or 15 mL PO PRN (max 8 doses/24 h) Caution: [C, D (3rd tri), –] Avoid w/ renal failure; h/o severe GI bleed Contra: Influenza or chickenpox (↑ risk of Reye synd), ASA allergy (see Aspirin) Disp: Chew tabs 262 mg; Caplets 262 mg, Liq 262, 525 mg/15 mL, susp 262 mg/15 mL SE: May turn tongue & stools black Interactions: ↑ Effects OF ASA, MTX, valproic acid; ↓ effects OF tetracyclines; ↓ effects W/ corticosteroids, probenecid Labs: ↑ Lipid levels; may interfere w/ GI tract x-rays NIPE: May darken tongue & stool, chew tab, N swallow whole Bisoprolol (Zebeta) [Antihypertensive/Beta-Blocker] Uses: *HTN* Action: Competitively blocks β1-adrenergic receptors Dose: 2.5–10 mg/d (max dose 20 mg/d); ↓ w/ renal impair Caution: [C (D 2nd & 3rd tri), +/–] Con- tra: Sinus bradycardia, AV conduction abnormalities, uncompensated cardiac failure Disp: Tabs 5, 10 mg SE: Fatigue, lethargy, HA, bradycardia, edema, CHF Notes: Not dialyzed; Interactions: ↑ Bradycardia W/ adenosine, amiodarone, digoxin, dipyridamole, neostigmine, physostigmine, tacrine; ↑ effects W/ cimetidine, fluoxetine, prazosin; ↓ effects W/ NSAIDs, rifampin; ↓ effects OF theophylline, glucagon Labs: ↑Alkaline phosphatase, BUN, cholesterol, glucose, K+, triglycerides, uric acid NIPE: N D/C abruptly, may mask S/Sxs hypoglycemia, take w/o regard to food Bivalirudin (Angiomax) [Anticoagulant/Direct Thrombin In- hibitor] Uses: *Anticoagulant w/ ASA in unstable angina undergoing PTCA, Botulinum Toxin Type A 59

PCI or in patients undergoing PCI w/ or at risk of HIT/HITTS* Action: Anticoagu- lant, thrombin inhibitor Dose: 0.75 mg/kg IV bolus, then 1.75 mg/kg/h for duration of procedure and up to 4 h post; ACT 5 min after bolus, may repeat 0.3 mg/kg bolus if necessary (give w/ ASA 300–325 mg/d; start pre-PTCA) Caution: [B, ?] Contra: Major bleeding Disp: Powder 250 mg for inj SE: Bleeding, back pain, N, HA Interactions: ↑ Risk of bleeding W/ heparin, warfarin, oral anticoagulants Labs: ↑ PT, PTT NIPE: Monitor venipuncture site for bleeding; instruct pt to watch for bleeding, bruising, or tarry stool Bleomycin Sulfate (Blenoxane) [Antineoplastic/Antibiotic] Uses: *Testis CA; Hodgkin Dz & NHLs; cutaneous lymphomas; & squamous cell CA (head & neck, larynx, cervix, skin, penis); malignant pleural effusion sclerosing agent* Action: Induces DNA breakage (scission) Dose: (Per protocols); ↓ w/ renal impair Caution: [D, ?] Severe pulm Dz (pulm fibrosis) Disp: Inj: Powder for recons 15, 30 units SE: Hyperpigmentation (skin staining) & allergy (rash to anaphylaxis); fever in 50%; lung tox (idiosyncratic & dose related); pneumonitis w/ fibrosis; Raynaud phenomenon, N/V Notes: Test dose 1 unit, especially in lymphoma pts; lung tox w/ total dose >400 units or single dose >30 units Interac- tions: ↑ Effects W/ cisplatin & other antineoplastic drugs; ↓ effects OF digoxin & phenytoin Labs: ↑ Uric acid, WBC; monitor BUN, Cr, pulmonary Fxn tests NIPE: Eval lungs for adventious sounds; transient hair loss; N immunizations, breast- feeding; use contraception method Bortezomib (Velcade) [Antineoplastic/Proteosome Inhibitor] WARNING: May worsen preexisting neuropathy Uses: *Rx multiple myeloma or mantel cell lymphoma with one previous Rx* Action: Proteasome inhibitor Dose: 1.3 mg/m2 bolus IV 2 ×/wk × 2 wk, w/ 10-day rest period (=1 cycle); ↓ dose w/ hematologic tox, neuropathy Caution: [D, ?/–] w/drugs CYP450 metabolized (Table 11) Disp: 3.5-mg vial SE: Asthenia, GI upset, anorexia, dyspnea, HA, orthostatic ↓ BP, edema, insomnia, dizziness, rash, pyrexia, arthralgia, neuropathy Interactions: ↑ Risk of peripheral neuropathy W/ amiodarone, antivirals, INH, nitrofurantoin, statins; ↑ risk hypotension W/ antihypertensives; ↑ effects W/ cimetidine, clarithromycin, diltiazem, disulfiram, erythromycin, fluoxetine, propoxyphene, verapamil, zafirlukast; ↓ effects W/ amiodarone, carbamazepine, phenobarbital, phenytoin, rifampin Labs: ↓ HMG, Hct, neutrophils, plts NIPE: N PRG or breast- feeding; use contraception; caution w/ driving due to fatigue/dizziness; ↑ fluids if C/O N/V Botulinum Toxin Type A (Botox, Botox Cosmetic) [Neuro- muscular Blocker/Neurotoxin] Uses: *Glabellar lines (cosmetic), blepharospasm, cervical dystonia, axillary hyperhidrosis, strabismus* Action: ↓ Acetylcholine release from nerve endings, ↓ neuromuscular transmission and local muscle activity; neurotoxin Dose: Adults: Glabellar lines (cosmetic): 0.1 mL IM × 5 sites q3–4mo; Blepharospasm: 1.25–2.5 units IM/site q3mo; max 200 units/30 d cum dose; Cervical dystonia: 198–300 units IM divided <100 units into 60 Brimonidine sternocleidomastoid; Hyperhidrosis, axillary: 50 units intradermal/axilla divided; Strabismus: 1.25–2.5 units IM/site q3mo; inject extraocular muscles w/ EMG guidance Peds: Blepharospasm >12 y: see Adults; Cervical dystonia >16 y: 198–300 units IM ÷ among affected muscles; use <100 units in sternocleidomastoid; Strabismus >12 y: 1.25–2.5 units IM/site q3mo; 25 units/site max; inject extraocular muscles w/ EMG guidance Caution: [C, ?] w/ neurologic Dz Contra: hypersensitivity to components, infect at inj site Disp: powder for reconst SE: Anaphylaxis, erythema multiforme, dysphagia, dyspnea, syncope, HA, NAG; Interactions: ↑ Effects W/ aminoglycosides, clindamycin, lincomycin, Mg sulfate, neuromuscular blockers, quinidine; NIPE: may cause inj site pain Brimonidine (Alphagan P) [Alpha Agonist/Glaucoma Agent] α Uses: *Open-angle glaucoma, ocular HTN* Action: 2-Adrenergic agonist Dose: 1 gtt in eye(s) tid (wait 15 min to insert contacts) Caution: [B, ?] Contra: MAOI therapy Disp: 0.15, 0.1% soln SE: Local irritation, HA, fatigue; Interactions: ↑ Effects OF antihypertensives, BBs, cardiac glycosides, CNS depressants; ↓ effects W/ TCAs NIPE: N EtOH, insert soft contact lenses 15 + min after drug use Brinzolamide (Azopt) [Carbonic Anhydrase Inhibitor/Glau- coma Agent] Uses: *Open-angle glaucoma, ocular HTN* Action: Carbonic anhydrase inhibitor Dose: 1 gtt in eye(s) tid Caution: [C, ?] Contra: Sulfonamide allergy Disp: 1% susp SE: Blurred vision, dry eye, blepharitis, taste disturbance Interactions: ↑ Effects W/ oral carbonic anhydrase inhibitors Labs: Check LFTs, BUN, Cr NIPE: N Use drug if ↓ renal & hepatic studies or allergies to sulfonamides; shake well before use; insert soft contact lenses 15 + min after drug use; wait 10 min before use of other topical ophthalmic drugs Bromocriptine (Parlodel) [Antiparkinson/Dopamine Recep- tor Agonist] Uses: *Parkinson Dz, hyperprolactinemia, acromegaly, pituitary tumors* Action: Direct-acting on the striatal dopamine receptors; ↓ prolactin secretion Dose: Initial, 1.25 mg PO bid; titrate to effect, w/ food Caution: [B, ?] Contra: Severe ischemic heart Dz or PVD Disp: Tabs 2.5 mg; caps 5 mg SE: ↓ BP, Raynaud phenomenon, dizziness, N, hallucinations; Interactions: ↑ Effects W/ erythromycin, fluvoxamine, nefazodone, sympathomimetics; ↓ effects W/ phenothiazines, antipsychotics; Labs: ↑ BUN, AST, ALT, CPK, alkaline phosphatase, uric acid NIPE: N Breast-feeding, PRG, OCPs; drug may cause intolerance to EtOH, return of menses & suppression of galactorrhea may take 6–8 wk; take drug with meals Budesonide (Rhinocort Aqua, Pulmicort) [Anti-inflammatory/ Glucocorticoid] Uses: *Allergic & nonallergic rhinitis, asthma* Action: Steroid Dose: Adults: Rhinocort Aqua 1–4 sprays/nostril/d; Turbuhaler 1–4 inhal bid; Pulmicort Flexhaler 1–2 inhal bid Peds: Rhinocort Aqua intranasal 1–2 sprays/nostril/d; Pulmicort Turbuhaler 1–2 inhal bid, Respules: 0.25–0.5 mg daily or bid (Rinse mouth after PO use) Caution: [C, ?/–] Disp: Met-dose Turbuhaler, 200 μg/inhalation; Flexhaler 90, 180 μg/inh,; Respules 0.25, 0.5 mg/2 mL; Bupivacaine 61

Rhinocort Aqua 32 μg/spray SE: HA, cough, hoarseness, Candida Infxn, epistaxis Interactions: ↑ Effects W/ ketoconazole, itraconazole, ritonavir, indinavir, saquinavir, erythromycin, and & grapefruit juice; NIPE: Shake inhaler well before use, rinse mouth & wash inhaler after use, swallow capsules whole, N exposure chickenpox or measles. Budesonide, oral (Entocort EC) [Anti-inflammatory, Corti- costeroid] Uses: *Mild-moderate Crohn Dz* Action: Steroid, anti-inflammatory Dose: Adults: Initial, 9 mg PO qAM to 8 wk max: maint 6 mg PO qAM taper by 3 mo; avoid grapefruit juice Contra: Active TB and fungal Infxn Caution: [C, ?/–] DM, glaucoma, cataracts, HTN, CHF Disp: Caps 3 mg ER SE: HA, cough, hoarseness, Candida Infxn, epistaxis; Interactions: ↑ effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit; Labs: ↑ Alkaline phosphatase, C-reactive protein, ESR, WBC; ↓ HMG, Hct NIPE: Do not cut/ crush/chew caps Budesonide/formoterol (Symbicort) [Anti-inflammatory, β Bronchodilator/Beta-2-Agonist] WARNING: Long-acting 2 agonists may ↑ risk of asthma-related death Uses: *Asthma maintenance * Action: β Steroid w/ LA 2-agonist Dose: Adult and Peds. >12 y: 2 inhal BID Caution: [C, ?] w/ transfer from systemic to inhal steroids Contra: acute attack Disp: Inhal 80/4.5, 160/4.5 SE: Allergic Rxns, HA, tremor, ↑ BP & HR, ↑ Infxn risk, throat irritation, growth ↓ in children Interactions: ↑ Effects W/ adrenergics; ↑ hypokalemic effects W/ cardiac glycosides, diuretics, steroids; ↑ risk of ventricular arrhythmias W/ MAOIs, TCA, quinidine, phenothiazines; ↓ effects W/ β-blockers Labs: ↑ Serum glucose; ↓ K+ NIPE: N EtOH Bumetanide (Bumex) [Diuretic/Loop] Uses: *Edema from CHF, hepatic cirrhosis, & renal Dz* Action: Loop diuretic; ↓ reabsorption of Na+ & Cl–, in ascending loop of Henle & the distal tubule Dose: Adults. 0.5–2 mg/d PO; 0.5–1 mg IV/IM q8–24h (max 10 mg/d) for PO and IV. Peds. 0.015–0.1 mg/kg/d PO, q6–24h Caution: [D, ?] Contra: Anuria, hepatic coma, severe electrolyte depletion Disp: Tabs 0.5, 1, 2 mg; inj 0.25 mg/mL SE: ↓ K+, ↓ Na+, ↑ Cr, ↑ uric acid, dizziness, ototox Notes: Monitor fluid & lytes Interactions: ↑ Effects W/ antihypertensives, thiazides, nitrates, EtOH, clofibrate; ↑ effects OF Li, warfarin, thrombolytic drugs, anticoagulants; ↑ K+ loss W/ carbenoxolone, corticosteroids, terbutaline; ↑ ototox W/ aminoglycosides, cisplatin; ↓ effects W/ cholestyramine, ↑ colestipol, NSAIDs, probenecid, barbiturates, phenytoin Labs: T4, T3, BUN, serum glucose, Cr, uric acid; ↓ serum K+, Ca2+, Mg+ NIPE: Take drug w/ food, take early to prevent nocturia, daily wt Bupivacaine (Marcaine) [Anesthetic] Uses: *Local, regional, & spinal anesthesia, local & regional analgesia* Action: Local anesthetic Dose: Adults & Peds. Dose dependent on procedure (tissue vascularity, depth of anesthesia, etc) (Table 2) Caution: [C, ?] Contra: Severe bleeding, ↓ BP, shock & arrhythmias, local Infxns at anesthesia site, septicemia Disp: Inj 0.25, 0.5, 0.75% 62 Buprenorphine

SE: ↓ BP, bradycardia, dizziness, anxiety Interactions: ↑ Effects W/ BBs, hyaluronidase, ergot-type oxytocics, MAOI, TCAs, phenothiazines, vasopressors, CNS depressants; ↓ effects W/ chloroprocaine NIPE: Anesthetized area has tem- porary loss of sensation & Fxn Buprenorphine (Buprenex) [C-V] [Analgesic/Opioid Agonist- Antagonist] Uses: *Moderate/severe pain* Action: Opiate agonist-antagonist Dose: 0.3–0.6 mg IM or slow IV push q6h PRN Caution: [C, ?/–] Disp: 0.3 mg/mL SE: Sedation, ↓ BP, resp depression Notes: Withdrawal if opioid-dependent Interactions: ↑ Effects of resp & CNS depression W/ EtOH, opiates, benzodiazepines, TCAs, MAOIs, other CNS depressants Labs: ↓ Alkaline phosphatase, HMG, Hct, erythrocyte count NIPE: N EtOH & other CNS depressants Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban) [Antidepressant/Smoking Cessation/Aminoketone] WARNING: Closely monitor for worsening depression or emergence of suicidality, increased suicidal behavior in young adults Uses: *Depression, adjunct to smoking cessation* ADHD Action: Weak inhibitor of neuronal uptake of serotonin & norepinephrine; ↓ neuronal dopamine reuptake Dose: Depression: 100–450 mg/d ÷ bid-tid; SR 150–200 mg bid; XR 150–450 mg daily. Smoking cessation (Zyban, Wellbutrin XR): 150 mg/d × 3 d, then 150 mg bid × 8–12 wk, last dose not after 6 PM; ↓ renal/hepatic impair Caution: [C, ?/–] Contra: Sz disorder, h/o anorexia nervosa or bulimia, MAOI, w/in 14 d, abrupt D/C of EtOH or sedatives Disp: Tabs 75, 100 mg; SR tabs 50, 100, 150, 200 mg; XR tabs 150, 300 mg; Zyban 150 mg tabs SE: Szs, agitation, insomnia, HA, tachycardia Notes: Avoid EtOH & other CNS depressants, SR and XR do not cut/chew/crush Interactions: ↑ Effects W/ cimetidine, levodopa, MAOIs; ↑ risk of Szs W/ EtOH, phenothiazines, antidepressants, theophylline, TCAs, or abrupt withdrawal of corticosteroids, benzodiazepines Labs: ↓ Prolactin level NIPE: Drug may cause Szs, take 3–4 wk for full effect, N EtOH or abrupt D/C Buspirone (BuSpar) [Anxiolytic] WARNING: Closely monitor for worsening depression or emergence of suicidality Uses: Short-term relief of *anxiety* Action: Antianxiety; antagonizes CNS serotonin receptors Dose: Initial: 7.5 mg PO bid; ↑ by 5 mg q2–3d to effect; usual 20–30 mg/d; max 60 mg/d Contra: w/ MAOI Caution: [B, ?/–] Avoid w/ severe hepatic/renal insuff Disp: Tabs ÷ dose 5, 10, 15, 30 mg SE: Drowsiness, dizziness, HA, N, EPS, serotonin synd, hostility, depression Notes: No abuse potential or physical/psychologic dependence Inter- actions: ↑ Effects W/ erythromycin, clarithromycin, itraconazole, ketoconazole, diltiazem, verapamil, grapefruit juice; ↓ effects W/ carbamazepine, rifampin, phenytoin, dexamethasone, phenobarbital, fluoxetine Labs: ↑ Glucose; ↓ WBC, plts NIPE: ↑ Sedation w/ EtOH, therapeutic effects may take up to 4 wk Busulfan (Myleran, Busulfex) [Antineoplastic/Alkylating Drug] Uses: *CML*, preparative regimens for allogeneic & ABMT in high doses Action: Alkylating agent Dose: (Per protocol) Caution: [D, ?] Disp: Tabs 2 mg, Calcitriol 63 inj 60 mg/10 mL SE: ↓ BM, pulm fibrosis, N (w/ high-dose), gynecomastia, adrenal insuff, & skin hyperpigmentation Interactions: ↑ Effects W/ acetaminophen; ↑ BM suppression W/ antineoplastic drugs & radiation therapy; ↑ uric acid levels W/ probenecid & sulfinpyrazone; ↓ effects W/ itraconazole, phenytoin Labs: ↑ Glucose, ALT, bilirubin, BUN, Cr, uric acid; monitor CBC, LFTs NIPE: N Immunizations, PRG, breast-feeding; ↑ fluids; use barrier contraception; ↑ risk of hair loss, rash, darkened skin pigment; ↑ susceptibility to Infx Butorphanol (Stadol) [C-IV] [Analgesic/Opiate Agonist- Antagonist] Uses: *Anesthesia adjunct, pain* & migraine HA Action: Opi- ate agonist-antagonist w/ central analgesic actions Dose: 1–4 mg IM or IV q3–4h PRN. Migraine: 1 spray in 1 nostril, repeat × 1 60–90 min, then q3–4h ↓ in renal impair Caution: [C (D if high dose or prolonged use at term), +] Disp: Inj 2 mg/mL; nasal 1 mg/spray SE: Drowsiness, dizziness, nasal congestion Interactions: ↑ Ef- fects W/ EtOH, antihistamines, cimetidine, CNS depressants, phenothiazines, barbiturates, skeletal-muscle relaxants, MAOIs; ↓ effects OF opiates Labs: ↑ Serum amylase & lipase NIPE: N EtOH or other CNS depressants; May induce withdrawal in opioid dependency Calcipotriene (Dovonex) [Keratolytic] Uses: *Plaque psoriasis* Action: Keratolytic Dose: Apply bid Caution: [C, ?] Contra: ↑ Ca2+; vitamin D tox; do not apply to face Disp: Cream; oint; soln 0.005% SE: Skin irritation, dermatitis Interactions: None noted Labs: Monitor serum Ca NIPE: Wash hands after application or wear gloves to apply, D/C drug if ↑ Ca Calcitonin (Fortical, Miacalcin) [Hypocalcemic, Bone Resorp- tion Inhibitor/Thyroid Hormone] Uses: *Paget Dz of bone, ↑ Ca2+*, osteogenesis imperfecta, *postmenopausal osteoporosis* Action: Polypep- tide hormone Dose: Paget Dz: 100 units/d IM/SC initial, 50 units/d or 50–100 units q1–3d maint. ↑ Ca2+ 4 units/kg IM/SC q12h; ↑ to 8 units/kg q12h, max q6h. Osteo- porosis: 100 units/qod IM/SQ; intranasal 200 units = 1 nasal spray/d Caution: [C, ?] Disp: Spray, nasal 200 units/activation; inj, salmon 200 units/mL (2 mL) SE: Facial flushing, N, inj site edema, nasal irritation, polyuria Notes: For nasal spray alternate nostrils daily; Interactions: Prior treatment w/ alendronate, risedronate, etidronate or pamidronate may ↓ effects of calcitonin Labs: ↓ Serum Li; monitor serum Ca and alkaline phosphatase NIPE: Allergy skin test prior to use; take at bedtime to inj is transient; nausea > inj will < w/ continued treatment Calcitriol (Rocaltrol, Calcijex) [Antihypocalcemic/Vitamin D Analog] Uses: *Reduction of ↑ PTH levels, ↓ Ca2+ on dialysis* Action: 1,25- Dihydroxycholecalciferol (vitamin D analog) Dose: Adults. Renal failure: 0.25 μg/d PO, ↑ 0.25 μg/d q4–6wk PRN; 0.5 μg 3 ×/wk IV, ↑ PRN. Hypoparathy- roidism: 0.5–2 μg/d. Peds. Renal failure: 15 ng/kg/d, ↑ PRN; maint 30–60 ng/kg/d. Hypoparathyroidism: <5 y, 0.25–0.75 μg/d. >6 y: 0.5–2 μg/d Caution: [C, ?] Contra: ↑ Ca2+; vitamin D tox Disp: Inj 1, 2 μg/mL (in 1-mL); caps 0.25, 0.5 μg; 64 Calcium Acetate sol 1 μg/mL SE: ↑ Ca2+ Interactions: ↑ Effect W/ thiazide diuretics; ↓ effect W/ cholestyramine, colestipol, ketoconazole Labs: Monitor for ↑ Ca2+, cholesterol, BUN, AST, ALT; ↓ alkaline phosphatase NIPE: N Mg-containing antacids or supls Calcium Acetate (PhosLo) [Calcium Supplement, Anti- Arrhythmic/Mineral, Electrolyte] Uses: *ESRD-associated hyper- 2+ ↓ 2– phosphatemia* Action: Ca supl w/o aluminum to PO4 absorption Dose: 2–4 tabs PO w/ meals Caution: [C, ?] Contra: ↑ Ca2+ Disp: Gelcap 667 mg SE: Can ↑ Ca2+, hypophosphatemia, constipation Interactions: ↑ Effects OF quinidine; ↓ effects W/ large intake of dietary fiber, spinach, rhubarb; ↓ effects OF atenolol, CCB, etidronate, tetracyclines, fluoroquinolones, phenytoin, Fe salts, thyroid hormones Labs: Monitor for ↑ Ca2+; ↓ Mg2+ NIPE: N EtOH, caffeine, tobacco; separate Ca supls and other meds by 1–2 h Calcium Carbonate (Tums, Alka-Mints) [Antacid, Calcium Supplement/Mineral, Electrolyte] [OTC] Uses: *Hyperacidity associated w/ peptic ulcer Dz, hiatal hernia, etc* Action: Neutralizes gastric acid Dose: 500 mg–2 g PO PRN; ↓ in renal impair Caution: [C, ?] Disp: Chew tabs 350, 420, 500, 550, 750, 850 mg; susp SE: ↑ Ca2+, ↓PO–4 constipation Interac- tions: ↓ Effect OF tetracyclines, fluoroquinolones, Fe salts, & ASA; ↓ Ca absorption W/ high intake of dietary fiber Labs: Monitor for ↑ Ca2+, ↓ Mg2+ NIPE: ↑ Fluids, may cause constipation, N EtOH, caffeine, tobacco; separate Ca supls and other meds by 1–2 h, chew tabs well Calcium Glubionate (Neo-Calglucon) [OTC] [Calcium Sup- plement, Anti-Arrhythmic/Mineral, Electrolyte] Uses: *Rx & prevent Ca deficiency* Action: Ca2+ supl Dose: Adults. 6–18 g/d ÷ doses. Peds. 600–2000 mg/kg/d ÷ qid (9 g/d max); ↓ in renal impair Caution: [C, ?] Contra: ↑ Ca2+ Disp: OTC syrup 1.8 g/5 mL = elemental Ca 115 mg/5 mL SE: ↑ Ca2+, ↓ PO–4 constipation; Interactions: ↑ Effects OF quinidine; ↓ effect OF tetracyclines; ↓ Ca absorption W/ high intake of dietary fiber Labs: ↑ Ca2+, ↓ Mg2+ NIPE: N EtOH, caffeine, tobacco, separate Ca supls and other meds by 1–2 h Calcium Salts (Chloride, Gluconate, Gluceptate) [Calcium Supplement, Anti-Arrhythmic/Mineral, Electrolyte] Uses: *Ca2+ replacement*, VF, Ca2+ blocker tox, Mg2+ intox, tetany, *hyperphosphatemia in ESRD* Action: Ca2+ supl/replacement Dose: Adults. Replacement: 1–2 g/d PO. Tetany: 1 g CaCl over 10–30 min; repeat in 6 h PRN; Hyperkalemia/calcium channel blocker overdose: 8–16 mg/kg (usually 5–10 mL) IV; 2–4 mg/kg (usually 2 mL) IV before IV Ca blockers (ECC 2005). Peds. Replacement: 200–500 mg/kg/24 h PO or IV ÷ qid. Cardiac emergency: 100 mg/kg/dose IV gluconate salt q10min. Tetany: 10 mg/kg CaCl over 5–10 min; repeat in 6 h or use inf (200 mg/kg/d max). Adult & Peds. ↓ Ca2+ due to citrated blood inf: 0.45 mEq Ca/100 mL citrated blood inf (↓ in renal impair) Caution: [C, ?] Contra: ↑ Ca2+ Disp: CaCl inj 10% = 100 mg/mL = Ca 27.2 mg/mL = 10-mL amp; Ca gluconate inj 10% = 100 mg/mL = Ca 9 mg/mL; tabs 500 mg = 45 mg Ca, 650 mg = 58.5 mg Ca, Captopril 65

975 mg = 87.75 mg Ca, 1 g = 90 mg Ca; Ca gluceptate inj 220 mg/mL = 18 mg/mL Ca SE: Bradycardia, cardiac arrhythmias, ↑ Ca2+ Notes: CaCl 270 mg (13.6 mEq) elemental Ca/g, & calcium gluconate 90 mg (4.5 mEq) Ca/g. RDA for Ca: Adults = 800 mg/d; Peds = <6 mo, 360 mg/d, 6 mo–1 y, 540 mg/d, 1–10 y, 800 mg/d, 10–18 y, 1200 mg/d Interactions: ↑ Effects OF quinidine and digitalis; ↓ effects OF tetracyclines, quinolones, verapamil, CCBs, Fe salts, ASA, atenolol; ↓ Ca absorption W/ high intake of dietary fiber Labs: Monitor for ↑ Ca2+, ↓ Mg2+ NIPE: N EtOH, caffeine, tobacco; separate Ca supls and other meds by 1–2 h Calfactant (Infasurf) [RDS Agent/Surfactant] Uses: *Prevention & Rx of RSD in infants* Action: Exogenous pulm surfactant Dose: 3 mL/kg instilled into lungs. Can retreat for a total of 3 doses given 12 h apart Caution: [?, ?] Disp: Intratracheal susp 35 mg/mL SE: Monitor for cyanosis, airway obst, bradycardia during administration Interactions: None noted NIPE: Only for intratracheal use; N Reconstitute, dilute, or shake vial; refrigerate & keep away from light; no need to warm soln prior to use Candesartan (Atacand) [Antihypertensive/ARB] Uses: *HTN*, DN, CHF Action: Angiotensin II receptor antagonist Dose: Z-32 mg/d (usual 16 mg/d) Caution: [C (1st tri), D (2nd & 3rd tri), –] Contra: Primary hyperaldosteronism; bilateral RAS Disp: Tabs 4, 8, 16, 32 mg SE: Dizziness, HA, flushing, angioedema Interactions: ↑ Effects W/ cimetidine; ↑ risk of hyperkalemia W/ amiloride, spironolactone, triamterene, K supls, trimethoprim; ↑ effects OF Li; ↓ effects W/ phenobarbital, rifampin Labs: ↑ BUN, Cr, K+, LFTs, uric acid; monitor for albuminuria, hyperglycemia, triglyceridemia, uricemia NIPE: N Breast-feeding or PRG, use barrier contraception, may take 4–6 wk for full effect, adequate fluid intake, take w/o regard to food Capsaicin (Capsin, Zostrix, others) [OTC] [Topical Anesthetic/ Analgesic] Uses: Pain due to *postherpetic neuralgia*, chronic neuralgia, *arthritis, diabetic neuropathy*, postop pain, psoriasis, intractable pruritus Action: Topical analgesic Dose: Apply tid-qid Caution: [C, ?] Disp: OTC creams; gel; lotions; roll-ons SE: Local irritation, neurotox, cough Note: Weeks to onset of action Interactions: May ↑ cough W/ ACEIs NIPE: External use only, N contact w/ eyes or broken/irritated skin, apply w/ gloves, transient stinging/burning Captopril (Capoten, others) [Antihypertensive/ACEI] Uses: *HTN, CHF, MI*, LVD, DN Action: ACE inhibitor Dose: Adults. HTN: Initial, 25 mg PO bid-tid; ↑ to maint q1–2wk by 25-mg increments/dose (max 450 mg/d) to effect. CHF: Initial, 6.25–12.5 mg PO tid; titrate PRN. LVD: 50 mg PO tid. DN: 25 mg PO tid. Peds. Infants <2 mo: 0.05–0.5 mg/kg/dose PO q8–24h. Children: Initial, 0.3–0.5 mg/kg/dose PO; ↑ to 6 mg/kg/d max in 2–4 divided doses; 1 h before meals Caution: [C (1st tri); D (2nd & 3rd tri) + ]; unknown effects in renal impair Contra: h/o angioedema, bilateral RAS Disp: Tabs 12.5, 25, 50, 100 mg SE: Rash, proteinuria, cough, ↑ K+ Interactions: ↑ Effects W/ antihypertensives, diuretics, nitrates, probenecid, black catechu; ↓ effects W/ antacids, ASA, NSAIDs, 66 Carbamazepine food; ↑ effects OF digoxin, insulin, oral hypoglycemics, Li Labs: False + urine acetone; may ↑ urine protein, serum BUN, Cr, K+, prolactin, LFTs; may ↓ HMG, Hct, RBC, WBC, plt NIPE: N PRG, breast-feeding, K-sparing diuretics; take w/o food, give 1 h < meals; may take 2 wk for full therapeutic effect Carbamazepine (Tegretol XR, Carbatrol, Epitol) [Anticon- vulsant/Analgesic] WARNING: Aplastic anemia & agranulocytosis have been reported w/ carbamazepine Uses: *Epilepsy, trigeminal neuralgia*, EtOH withdrawal Action: Anticonvulsant Dose: Adults. Initial, 200 mg PO bid; or 100 mg 4 ×/d as susp; ↑ by 200 mg/d; usual 800–1200 mg/d ÷ doses. Peds. <6 y: 5 mg/kg/d, ↑ to 10–20 mg/kg/d ÷ in 2–4 doses. 6–12 y: Initial, 100 mg PO bid or 10 mg/kg/24 h PO ÷ daily-bid; ↑ to maint 20–30 mg/kg/24 h ÷ tid-qid; ↓ in renal impair; take w/ food Caution: [D, +] Contra: MAOI use, h/o BM suppression Disp: Tabs 100, 200, 300, 400 mg; chew tabs 100 mg, 200 mg; XR tabs 100, 200, 400 mg; caps ER 100, 200, 300 mg; susp 100 mg/5 mL SE: Drowsiness, dizziness, blurred vision, N/V, rash, ↓ Na+, leukopenia, agranulocytosis Notes: Trough: Just before next dose. Therapeutic: Peak 8–12 μg/mL (monotherapy), 4–8 (polyther- apy). Toxic trough > 12 μg/mL. 1/2 life: 15–20 h; generic products not interchangeable, administer susp in 3–4 ÷ doses daily Interactions: ↑ Effects W/ cimetidine, clarithromycin, danazol, diltiazem, felbamate, fluconazole, fluoxetine, fluvoxamine, INH, itraconazole, ketoconazole, macrolides, metronidazole, propoxyphene, protease inhibitors, valproic acid, verapamil, grapefruit juice; ↑ effects OF Li, MAOIs; ↓ effects W/ phenobarbital, phenytoin, primidone, plantain; ↓ effects OF benzodiazepines, corticosteroids, cyclosporine, doxycycline, felbamate, haloperidol, OCPs, phenytoin, theophylline, thyroid hormones, TCAs, warfarin Labs: ↑ BUN, eosinophil count; ↓ HMG, Hct, WBC, plts, LFTs, thyroid hormones NIPE: Take w/ food; may cause photosensitivity—use sunscreen; use barrier contraception; abrupt withdrawal may cause Sz; N breast-feeding or PRG Carbidopa/Levodopa (Sinemet, Parcopa) [Antiparkinsonian/ Dopamine Agonist] Uses: *Parkinson Dz* Action: ↑ CNS dopamine levels Dose: 25/100 mg bid-qid; ↑ as needed (max 200/2000 mg/d) Caution: [C, ?] Contra: NAG, suspicious skin lesion (may activate melanoma), melanoma, MAOI use Disp: Tabs (mg carbidopa/mg levodopa) 10/100, 25/100, 25/250; tabs SR (mg carbidopa/mg levodopa) 25/100, 50/200; ODT (oral disintegrating tab) 10/100, 25/100, 25/250, SE: Psychiatric disturbances, orthostatic ↓ BP, dyskinesias, cardiac arrhythmias Interactions: ↑ Risk of hypotension W/ antihypertensives; ↑ risk of HTN W/ MAOIs; ↑ effects W/ antacids; ↓ effects W/ anticholinergics, anticonvulsants, benzodiazepines, haloperidol, Fe, methionine, papaverine, phenothiazines, phenytoin, pyridoxine, reserpine, spiramycin, tacrine, thioxanthenes, high-protein food Labs: ↑ Alkaline phosphatase, aspartate aminotransferase, bilirubin, BUN, uric acid ↓ HMG, plts, WBCs NIPE: Darkened urine & sweat may result, N crush or chew SR tabs, take w/o food; muscle or eyelid twitching may suggest tox Carmustine 67

Carboplatin (Paraplatin) [Antineoplastic/Alkylating Agent] WARNING: Administration only by provider experienced in cancer chemotherapy; BM suppression possible, Anaphlaxis may occur Uses: *Ovarian*, lung, head & neck, testicular, urothelial, & brain *CA, NHL* & allogeneic & ABMT in high doses Action: DNA cross-linker; forms DNA-platinum adducts Dose: 360 mg/m2 (ovarian carcinoma); AUC dosing 4–7 mg/mL (Culvert formula: mg = AUC × [25 + calculated GFR]); adjust based on plt count, CrCl, & BSA (Egorin formula); up to 1500 mg/m2 used in ABMT setting (per protocols) Caution: [D, ?] Contra: Severe BM suppression, excessive bleeding Disp: Inj 50, 150, 450 mg vial (10 mg/mL) SE: Anaphylaxis, ↓ BM, N/V/D, nephrotox, hematuria, neurotox, Notes: Physiologic dosing based on Culvert or Egorin formula allows ↑ doses w/ ↓ tox Interactions: ↑ Myelosuppression W/ myelosuppressive drugs; ↑ hematologic effects W/ BM suppressants; ↑ bleeding W/ ASA; ↑ nephrotox W/ nephrotoxic drugs; ↓ effects OF phenytoin Labs: Monitor for ↑ LFTs, BUN, Cr;↓ Mg2+, K+, Na+, Ca2+, HMG, Hct, neutrophils, plts, RBC, WBC NIPE: N Use w/ Al needles or IV administration sets, PRG, breast-feeding; antiemetics prior to admin may prevent N/V, maintain adequate food & fluid intake Carisoprodol (Soma) [Skeletal Muscle Relaxant/Carbamate Derivative] Uses: *Adjunct to sleep & physical therapy to relieve painful musculoskeletal conditions* Action: Centrally acting muscle relaxant Dose: 350 mg PO tid-qid Caution: [C, M] Tolerance may result; w/ renal/hepatic impair Contra: Allergy to meprobamate; acute intermittent porphyria Disp: Tabs 350 mg SE: CNS depression, drowsiness, dizziness, tachycardia Interactions: ↑ Effects W/ CNS depressants, phenothiazines, EtOH NIPE: Avoid EtOH & other CNS depressants; available in combo w/ ASA or codeine; N breast-feeding; take w/ food if GI upset Carmustine [BCNU] (BiCNU, Gliadel) [Antineoplastic, Alky- lating Agent] Uses: *Primary brain tumors, melanoma, Hodgkin lymphoma & NHLs, multiple myeloma, & induction for allogeneic & ABMT in high doses; adjunct to surgery in pts w/ recurrent glioblastoma* Action: Alkylating agent; nitrosourea forms DNA cross-links to inhibit DNA Dose: 150–200 mg/m2 q6–8wk single or ÷ dose daily inj over 2 d; 20–65 mg/m2 q4–6wk; 300–900 mg/m2 in BMT (per protocols); ↓ w/ hepatic impair Caution: [D, ?] Renal/hepatic impair Contra: ↓ BM, PRG Disp: Inj 100 mg/vial; wafer: 7.7 mg SE: ↓BP, N/V, ↓ WBC & plt, phlebitis, facial flushing, hepatic/renal dysfunction, pulm fibrosis, optic neurore- tinitis; hematologic tox may persist 4–6 wk after dose Notes: Do not give course more frequently than q6wk (cumulative tox) Interactions: ↑ Bleeding W/ ASA, anticoagulants, NSAIDs; ↑ hepatic dysfunction W/ etoposide; ↑ suppression of BM W/ cimetidine, radiation or additional antineoplastics; ↓ effects OF phenytoin, digoxin; ↓ pulmonary Fxn Labs: ↑ AST, alkaline phosphatase, bilirubin; ↓ HMG, Hct, WBC, RBC, plt counts; monitor PFTs NIPE: N PRG, breast-feeding, exposure to Infxns, ASA products; baseline PFTs 68 Carteolol

Carteolol (Cartrol, Ophthalmic) [Beta-Blocker/Glaucoma Agent] Uses: *HTN, ↑ intraocular pressure, chronic open-angle glaucoma* β β β Action: Blocks -adrenergic receptors ( 1, 2), mild ISA Dose: Ophth 1 gt in eye(s) bid Caution: [C (1st tri); D (2nd & 3rd tri), ?/–] Cardiac failure, asthma Contra: Sinus bradycardia; heart block >1st degree; bronchospasm Disp: Ophth soln 1% SE: Drowsiness, sexual dysfunction, bradycardia, edema, CHF; ocular: conjunctival hyperemia, anisocoria, keratitis, eye pain; Interactions: ↑ Effects W/ amiodarone, adenosine, barbiturates, CCBs, clonidine, digoxin, dipyridamole, fluoxetine, rifampin, tacrine, nitrates, EtOH; ↑α-adrenergic effects W/ amphetamines, cocaine, ephedrine, epinephrine, phenylephrine; ↑ effects OF theophylline; ↓ effects W/ antacids, NSAIDs, thyroid drugs; ↓ effects OF hypoglycemics, theophylline, dopamine Labs: ↑ BUN, uric acid, K+, serum lipoprotein, triglycerides, glucose NIPE: Ophthalmic drug may cause photophobia & risk of burning; may ↑ cold sensitivity, mental confusion; no value in CHF Carvedilol (Coreg, Coreg CR) [Antihypertensive/Alpha-1- & Beta-Blocker] Uses: *HTN, mild to severe CHF, LV dysfunction post MI* β β Action: Blocks adrenergic receptors, 1, 2, a1 Dose: HTN: 6.25–12.5 mg bid. CHF: 3.125–25 mg bid; w/ food to minimize ↓ BP Caution: [C (1st tri); D (2nd & 3rd tri), ?/–] asthma, DM Contra: Decompensated CHF, 2nd-/3rd-degree heart block, SSS, severe bradycardia w/o pacemaker, asthma, severe hepatic impair Disp: Tabs 3.125, 6.25, 12.5, 25 mg SE: Dizziness, fatigue, hyperglycemia, may mask/potentiate hypoglycemia, bradycardia, edema, hypercholesterolemia Interac- tions: ↑ Effects W/ cimetidine, clonidine, MAOIs, reserpine, verapamil, fluoxetine, paroxetine, EtOH; ↑ effects OF digoxin, hypoglycemics, cyclosporine, CCBs; ↓ effects W/ rifampin, NSAIDs Labs: ↑ LFTs, K+, triglycerides, uric acid, BUN, Cr, alkaline phosphatase, glucose; ↓ pt, INR, plts NIPE: Do not D/C abruptly; food slows absorption but reduces risk of dizziness; may cause dry eyes w/ contact lenses Caspofungin (Cancidas) [Antifungal/Echinocandin] Uses: *Invasive aspergillosis refractory/intolerant to standard therapy, esophageal candidiasis* Action: Echinocandin; ↓ fungal cell wall synth; highest activity in re- gions of active cell growth Dose: 70 mg IV load day 1, 50 mg/d IV; slow inf; ↓ in hepatic impair Caution: [C, ?/–] Do not use w/ cyclosporine; not studied as initial therapy Contra: Allergy to any component Disp: Inj 50, 70 mg powder for recons SE: Fever, HA, N/V, thrombophlebitis at site Interactions: ↑ Effects W/ cyclosporine; ↓ effects W/ carbamazepine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifampin; ↓ effect OF tacrolimus Labs: ↑ LFTs, serum alkaline phosphatase, eosinophils, PT, urine protein & RBCs; ↓ K+, Hgb, Hct NIPE: Monitor during inf; infuse slowly over 1 h & N mix w/ other drugs; limited experience beyond 2 wk of therapy Cefaclor (Ceclor, Raniclor) [Antibiotic/Cephalosporin-2nd Gener- ation] Uses: *Bacterial Infxns of the upper & lower resp tract, skin, bone, urinary tract, abdomen, gynecologic system* Action: 2nd-gen cephalosporin; ↓ cell wall synth. Cefdinir 69

Spectrum: More gram(–) activity than 1st-gen cephalosporins; effective against gram(+) (S. aureus); good gram(–) coverage against H. influenzae Dose: Adults. 250–500 mg PO tid; XR 375–500 mg bid. Peds. 20–40 mg/kg/d PO ÷ 8–12 h; ↓ renal impair Caution: [B, +] Contra: Cephalosporin allergy Disp: Caps 250, 500 mg; Tabs ER 375, 500 mg chew tabs 125, 187, 250, 375 mg; susp 125, 187, 250, 375 mg/5 mL SE: D, rash, eosinophilia, ↑ transaminases Interactions: ↑ Bleeding W/ anticoagulants; ↑ nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Labs: ↑ LFTs, alkaline phosphatase, bilirubin, BUN, Cr; ↓ Hgb, Hct, plts, WBC; false + direct Coombs test NIPE: Take w/ food to 12 y: Skin: 200 mg PO bid × 10 d. Chronic bronchitis, pharyngitis, tonsillitis: 400 mg PO bid × 10 d; avoid antacids w/in 2 h; take w/ meals; ↓ in renal impair Caution: [B, ?] Renal/hepatic impair Contra: Cephalosporin/PCN allergy, milk protein, or carnitine deficiency Disp: 200-mg tabs SE: HA, N/V/D, colitis, nephrotox, hepatic dysfunction, Stevens-Johnson synd, toxic epidermal necrolysis, allergic Rxns Notes: Causes renal excretion of carnitine; tablets contain milk protein Interactions: ↑ Bleeding W/ anticoagulants; ↑ nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Labs: ↑ LFTs; ↓ HMG, Hct, PT; false + direct Coombs test NIPE: High-fat meal will increase bioavailability; monitor for super Infxn; report persistent D; N antacids within 2 h of this drug; Cefepime (Maxipime) [Antibiotic/Cephalosporin-4th Gener- ation] Uses: *UTI, pneumonia, febrile neutropenia, skin/soft tissue Infxns* Action: 4th-gen cephalosporin; ↓ cell wall synth. Spectrum: gram(+) S. pneumoniae, S. aureus, gram(–) K. pneumoniae, E. coli, P. aeruginosa, Enterobacter sp Dose: Adults. 1–2 g IV q6-12h. Peds. 50 mg/kg q8h for febrile neutropenia; 50 mg/kg bid for skin/soft tissue Infxns; ↓ in renal impair Caution: [B, +] Con- tra: Cephalosporin allergy Disp: Inj 500 mg, 1, 2 g SE: Rash, pruritus, N/V/D, fever, HA, (+) direct Coombs test w/o hemolysis Notes: Give IM or IV Interac- tions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs; ↓ HMG, Hct, PT; false + direct Coombs test NIPE: Monitor for super Infxn; report persistent D; monitor inf site for inflammation Cefixime (Suprax) [Antibiotic/Cephalosporin-3rd Genera- tion] Uses: *Infxns of the resp tract, skin, bone, & urinary tract* Action: 3rd- gen cephalosporin; ↓ cell wall synth. Spectrum: S. pneumoniae, S. pyogenes, H. influenzae, & Enterobacteriaceae Dose: Adults. 400 mg PO daily-bid. Peds. 8–20 mg/kg/d PO ÷ daily-bid; ↓ in renal impair Caution: [B, +] Contra: Cephalosporin allergy Disp: Susp 100 mg/5 mL, 200 mg/5 mL SE: N/V/D, flatulence, & abd pain Notes: Monitor renal & hepatic Fxn; use susp for otitis media Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ nifedipine, probenecid; Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGt, eosinophils, BUN, Cr; Cefoxitin 71

↓ HMG, Hct, plts, WBC; false + direct Coombs test NIPE: monitor for super Infxn; after mixing suspension it is stable for 14 d without refrigeration Cefoperazone (Cefobid) [Antibiotic/Cephalosporin-3rd Generation] Uses: *Rx Infxns of the resp, skin, urinary tract, sepsis* Action: 3rd-gen cephalosporin; ↓ bacterial cell wall synth. Spectrum: Gram(–) (eg, E. coli, Klebsiella sp), P. aeruginosa but < ceftazidime; gram(+) variable against Streptococcus & Staphylococcus sp Dose: Adults. 2–4 g/d IM/IV ÷ q8–12h (12 g/d max). Peds. (Not approved) 100–150 mg/kg/d IM/IV ÷ bid-tid (12 g/d max); ↓ in renal/hepatic impair Caution: [B, +] May ↑ bleeding risk Contra: Cephalosporin allergy Disp: Powder for inj 1, 2, 10 g SE: D, rash, eosinophilia, ↑ LFTs, hypoprothrombinemia, & bleeding (due to MTT side chain) Notes: May interfere w/ warfarin Interactions: ↑ Bleeding W/ anticoagulants; ↑ nephrotox W/ aminoglycosides, loop diuretics Labs: ↑ LFTs, eosinophils, BUN, Cr; ↓ HMG, Hct, plts; NIPE: Monitor for super Infxn Cefotaxime (Claforan) [Antibiotic/Cephalosporin-3rd Gen- eration] Uses: *Rx Infxns of resp tract, skin, bone, urinary tract, meningitis, sepsis* Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Most gram(–) (not Pseudomonas sp), some gram(+) cocci (not Enterococcus sp); many PCN- resistant pneumococci Dose: Adults. 1–2 g IV q4–12h. Peds. 50–200 mg/kg/d IV ÷ q 4–12h; ↓ dose renal/hepatic impair Caution: [B, +] Arrhythmia w/ rapid inj; w/ colitis Contra: Cephalosporin allergy Disp: Powder for inj 500 mg, 1, 2, 10, 20 g, premixed inf 20 mg/mL, 40 mg/mL SE: D, rash, pruritus, colitis, eosinophilia, ↑ transaminases Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGt, eosinophils, BUN, Cr; ↓ HMG, Hct, plts, WBC NIPE: Monitor for super Infxn; IM inj deep into large muscle mass; rotate infusion sites Cefotetan (Cefotan) [Antibiotic/Cephalosporin-2nd Genera- tion] Uses: *Rx Infxns of the upper & lower resp tract, skin, bone, urinary tract, abdomen, & gynecologic system* Action: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Less active against gram(+); anaerobes including B. fragilis; gram(–), including E. coli, Klebsiella sp, Proteus sp Dose: Adults. 1–3 g IV q12h. Peds. 20–40 mg/kg/divided IV ÷ q12h; ↓ w/ renal impair Caution: [B, +] May ↑ bleeding risk; w/ h/o of PCN allergies, w/ other nephrotoxic drugs Contra: Cephalosporin allergy Disp: Powder for inj 1, 2, 10 g SE: D, rash, eosinophilia, ↑ transaminases, hypoprothrombinemia, & bleeding (due to MTT side chain) Notes: May interfere w/ warfarin Interactions: ↑ Bleeding W/ anticoagulants; ↑ nephrotox W/ aminoglycosides, loop diuretics Labs: ↑ LFTs, eosinophils; ↓ HMG, Hct, plts NIPE: Monitor for super Infxn; rotate inf sites Cefoxitin (Mefoxin) [Antibiotic/Cephalosporin-2nd Genera- tion] Uses: *Rx Infxns of the upper & lower resp tract, skin, bone, urinary tract, abdomen, & gynecologic system* Action: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Good gram(–) against enteric bacilli (ie, E. coli, Klebsiella sp, & 72 Cefpodoxime

Proteus sp); anaerobic B. fragilis Dose: Adults. 1–2 g IV q6–8h. Peds. 80–160 mg/kg/d ÷ q4–6h; ↓ in renal impair Caution: [B, +] Contra: Cephalosporin allergy Disp: Powder for inj 1, 2, 10 g SE: D, rash, eosinophilia, ↑ transaminases In- teractions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Monitor for super Infxn, report persistent D Cefpodoxime (Vantin) [Antibiotic/Cephalosporin-3rd Gen- eration] Uses: *Rx resp, skin, & urinary tract Infxns* Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: S. pneumoniae or non-β-lactamase- producing H. influenzae; acute uncomplicated N. gonorrhoeae; some uncomplicated gram(–) (E. coli, Klebsiella sp, Proteus sp) Dose: Adults. 100–400 mg PO q12h. Peds. 10 mg/kg/d PO ÷ bid; ↓ in renal impair, w/ food Caution: [B, +] Contra: Cephalosporin allergy Disp: Tabs 100, 200 mg; susp 50, 100 mg/5 mL SE: D, rash, HA, eosinophilia, ↑ transaminases Notes: Drug interactions w/ agents that ↑ gastric pH Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts; false + direct Coombs test; NIPE: Food will ↑ absorption & < GI upset, monitor for super Infxn; N take within 2 hr of antacids Cefprozil (Cefzil) [Antibiotic/Cephalosporin-2nd Generation] Uses: *Rx resp tract, skin, & urinary tract Infxns* Action: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Active against MSSA, strep, & gram(–) bacilli (E. coli, Klebsiella sp, P. mirabilis, H. influenzae, Moraxella sp) Dose: Adults. 250–500 mg PO daily-bid. Peds. 7.5–15 mg/kg/d PO ÷ bid; ↓ in renal impair Cau- tion: [B, +] Contra: Cephalosporin allergy Disp: Tabs 250, 500 mg; susp 125, 250 mg/5 mL SE: D, dizziness, rash, eosinophilia, ↑ transaminases Notes: Use higher doses for otitis & pneumonia Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Food will ↑ absorption & < GI upset, monitor for super Infxn; N take within 2 h of antacids; stable after reconsitution for 14 d—keep refrigerated Ceftazidime (Fortaz, Tazicef) [Antibiotic/Cephalosporin-3rd Generation] Uses: *Rx resp tract, skin, bone, urinary tract Infxns, meningitis, & septicemia* Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: P. aeruginosa, good gram(–) activity Dose: Adults. 500–2 g IV/IM q8–12h. Peds. 30–50 mg/kg/dose IV q8h; ↓ in renal impair Caution: [B, +] PCN sensitivity Con- tra: Cephalosporin allergy Disp: Powder for inj 500 mg, 1, 2, 6 g SE: D, rash, eosinophilia, ↑ transaminases Notes: Use only for proven or strongly suspected Infxn to ↓ development of drug resistance Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Cefuroxime 73

Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Food will ↑ absorption & < GI upset, monitor for super Infxn; N take within 2 h of antacids; stable after reconsitution for 14 d—keep refrigerated Ceftibuten (Cedax) [Antibiotic/Cephalosporin-3rd Genera- tion] Uses: *Rx resp tract, skin, urinary tract Infxns & otitis media* Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: H. influenzae & M. catarrhalis; weak against S. pneumoniae Dose: Adults. 400 mg/d PO. Peds. 9 mg/kg/d PO; ↓ in renal impair; take on empty stomach (susp) Caution: [B, +] Contra: Cephalosporin allergy Disp: Caps 400 mg; susp 90 mg/5 mL SE: D, rash, eosinophilia, ↑ transaminases Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↓ effects W/ antacids, chloramphenicol Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Take oral suspension 1 h < or 2 h > a meal; monitor for super Infxn; stable after reconsitution for 14 d—keep refrigerated Ceftizoxime (Cefizox) [Antibiotic/Cephalosporin-3rd Gener- ation] Uses: *Rx resp tract, skin, bone, & urinary tract Infxns, meningitis, septicemia* Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Good gram(–) bacilli (not Pseudomonas sp), some gram(+) cocci (not Enterococcus sp), & some anaerobes Dose: Adults. 1–4g IV q8–12h. Peds. 150–200 mg/kg/d IV ÷ q6–8h; ↓ in renal impair Caution: [B, +] Contra: Cephalosporin allergy Disp: Inj 1, 2, 10 g SE: D, fever, rash, eosinophilia, thrombocytosis, ↑ transaminases Inter- actions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Monitor for super Infxn; stable after reconsitution for 1 d at room temperature and 4 d if refrigerated; IM injection deep into large muscle mass Ceftriaxone (Rocephin) [Antibiotic/Cephalosporin-3rd Gen- eration] Uses: *Resp tract (pneumonia), skin, bone, urinary tract Infxns, meningitis, & septicemia*; Action: 3rd-gen cephalosporin; ↓ cell wall synth. Spec- trum: Moderate gram(+); excellent against β-lactamase producers Dose: Adults. 1–2 g IV/IM q12–24h. Peds. 50–100 mg/kg/d IV/IM ÷ q12–24h; ↓ in renal impair Caution: [B, +] Contra: Cephalosporin allergy; hyperbilirubinemic neonates Disp: Powder for inj 250 mg, 500 mg, 1, 2, 10 g; premixed 10, 20, 40 mg/mL SE: D, rash, leukopenia, thrombocytosis, eosinophilia, ↑ transaminases Interactions: ↑ Nephro- tox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Monitor for super Infxn, solutions are stable for 24 h at room temperature after dilution; IM injections deep into large muscle mass Cefuroxime (Ceftin [PO], Zinacef [parenteral]) [Antibiotic/ Cephalosporin-2nd Generation] Uses: *Upper & lower resp tract, skin, bone, urinary tract, abdomen, gynecologic Infxns* Action: 2nd-gen 74 Celecoxib cephalosporin; ↓ cell wall synth. Spectrum: Staphylococci, group B streptococci, H. influenzae, E. coli, Enterobacter sp, Salmonella sp, & Klebsiella sp Dose: Adults. 750 mg–1.5 g IV q6h or 250–500 mg PO bid. Peds. 100–150 mg/kg/d IV ÷ q8h or 20–30 mg/kg/d PO ÷ bid; ↓ in renal impair; take w/ food Caution: [B, +] Contra: Cephalosporin allergy Disp: Tabs 125, 250, 500 mg; susp 125, 250 mg/ 5 mL; powder for inj 750 mg, 1.5, 7.5 g SE: D, rash, eosinophilia, ↑ LFTs Notes: Cefuroxime film-coated tabs & susp not bioequivalent; do not substitute on a mg/mg basis; IV crosses blood–brain barrier Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid; ↑ effects W/ Al & Mg antacids Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Monitor for super Infxn; high-fat meals increased drug bioavailability; give suspension with food; IM injections deep into large muscle mass Celecoxib (Celebrex) [Anti-Inflammatory/COX-2 Inhibitor] WARNING: ↑ Risk of serious CV thrombotic events, MI & stroke, can be fatal; ↑ risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines; can be fatal Uses: *Osteoarthritis & RA, ankylosing spondylitis; acute pain, primary dysmenorrhea; preventive in familial adenomatous polyposis* Action: NSAID; ↓ COX-2 pathway Dose: 100–200 mg/d or bid; FAP: 400 mg PO bid; ↓ w/ hepatic impair; take w/ food/milk Caution: [C/D (3rd tri), ?] w/ renal impair Contra: Sulfonamide allergy, periop CABG Disp: Caps 100, 200 400 mg SE: See Warning; GI upset, HTN, edema, renal failure, HA Interactions: ↑ Effects W/ fluconazole; ↑ effects OF Li; ↑ risks of GI upset &/or bleeding W/ ASA, NSAIDs, warfarin, EtOH; ↓ effects W/ Al- & Mg-containing antacids, ↓ effects OF thiazide diuretics, loop diuretics, ACEIs Labs: ↑ LFTs, BUN, Cr, CPK, alkaline phosphatase; monitor for hypercholesterolemia, hyperglycemia, hypokalemia, hypophosphatemia, albuminuria, hematuria NIPE: Take w/ food if GI distress; watch for Sxs of GI bleed; no effect on plt/bleeding time; can affect drugs metabolized by P-450 pathway Cephalexin (Keflex, Pranixine Disperdose) [Antibiotic/ Cephalosporin-1st Generation] Uses: *Skin, bone, upper/lower resp tract, urinary tract Infxns* Action: 1st-gen cephalosporin; ↓ cell wall synth. Spec- trum: Streptococcus sp, Staphylococcus sp, E. coli, Proteus sp, & Klebsiella sp Dose: Adults. 250–1000 mg PO qid. Peds. 25–100 mg/kg/d PO ÷ qid; ↓ in renal impair; (on empty stomach) Caution: [B, +] Contra: Cephalosporin allergy Disp: Caps 250, 500 mg; tabs for oral susp 100, 125, 250 mg; susp 125, 250 mg/5 mL SE: D, rash, eosinophilia, ↑ LFTs Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Food will ↑ absorption and < GI upset; monitor for super Infxn; oral suspension stable for 14 d after reconstitution if refrigerated Charcoal, Activated 75

Cephradine (Velosef) [Antibiotic/Cephalosporin-1st Gener- ation] Uses: *Respiratory, GU, GI, skin, soft tissue, bone, & joint Infxns* Ac- tion: 1st-gen cephalosporin; ↓ cell wall synth. Spectrum: Gram(+) bacilli & cocci (not Enterococcus sp); some gram(–) (E. coli, Proteus sp, Klebsiella sp) Dose: Adults. 250–500 mg q6–12h (8 g/d max). Peds >9 mo. 25–100 mg/kg/d ÷ bid-qid (4 g/d max); ↓ in renal impair Caution: [B, +] Contra: Cephalosporin allergy Disp: Caps: 250, 500 mg; powder for susp 125, 250 mg/5 mL SE: Rash, eosinophilia, ↑ LFTs, N/V/D Interactions: ↑ Nephrotox W/ aminoglycosides, loop diuretics; ↑ effects W/ probenecid Labs: ↑ LFTs, alkaline phosphatase, bilirubin, LDH, GGT, eosinophils, BUN, Cr; ↓ HMG, Hct, plts NIPE: Food will ↑ absorption and < GI upset; monitor for super Infxn; oral suspension stable for 14 d after reconstitution if refrigerated Cetirizine (Zyrtec, Zyrtec D) [Allergy/Antihistamine] Uses: *Allergic rhinitis & other allergic Sxs including urticaria* Action: Nonsedating antihistamine Dose: Adults & Children >6 y. 5–10 mg/d. Zyrtec D 5/120 mg PO bid whole Peds. 6–11 mo: 2.5 mg daily. 12–23 mo: 2.5 mg daily-bid; ↓ in renal/hepatic impair Caution: [B, ?/–] Elderly & nursing mothers; >10 mg/d may cause drowsiness Contra: Allergy to cetirizine, hydroxyzine Disp: Tabs 5, 10 mg; chew tabs 5, 10 mg; syrup 5 mg/5 mL; Zyrtec D: Tabs 5/120 mg (cetirizine/pseudoephedrine) SE: HA, drowsiness, xerostomia Interactions: ↑ Effects W/ anticholinergics, CNS depressants, theophylline, EtOH Labs: May cause false—w/ allergy skin tests NIPE: N take w/ EtOH or CNS depressants; can cause sedation; sun exposure can cause photosensitivity Cetuximab (Erbitux) [Antineoplastic/Recombinant Mono- clonal Antibody] WARNING: Severe inf Rxns including rapid onset of airway obst (bronchospasm, stridor, hoarseness), urticaria, & ↓ BP; permanent D/C required; ↑ risk sudden death and cardiopulm arrest Uses: *EGFR + met colorectal CA w/wo irinotecan, unresectable head/neck SCC w/ RT; monotherapy in met head/neck cancer* Action: Human/mouse recombinant MoAb; binds EGFR, ↓ tumor cell growth Dose: Per protocol; load 400 mg/m2 IV over 2 h; 250 mg/m2 given over 1 h 1 × wk Caution: [C, –] Disp: Inj 100 mg/50 mL SE: Acneform rash, asthenia/malaise, N/V/D, abd pain, alopecia, inf Rxn, derm tox, interstitial lung disease, fever, sepsis, dehydration, kidney failure, PE Notes: Assess tumor for EGFR before Rx; pretreat w/ diphenhydramine; w/ mild SE ↓ inf rate by 50% NIPE: Monitor for inf reactions for 1 h after inf; during 1st 2 wk observe for skin tox; limit sun exposure Charcoal, Activated (Superchar, Actidose, Liqui-Char) [Adsor- bent] Uses: *Emergency poisoning by most drugs & chemicals (see Contra)* Action: Adsorbent detoxicant Dose: Give w/ 70% sorbitol (2 mL/kg); repeated use of sorbitol not OK Adults. Acute intox: 30–100 g/dose. GI dialysis: 20–50 g q6h for 1–2 d. Peds 1–12 y. Acute intox: 1–2 g/kg/dose. GI dialysis: 5–10 g/dose q4–8h 76 Chloral Hydrate

Caution: [C, ?] May cause V (hazardous w/ petroleum & caustic ingestions); do not mix w/ dairy Contra: Not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, EtOH, methanol poisoning, Li; do not use sorbitol in pts w/ fruc- tose intolerance, intestional obst, nonintact GI tracts Disp: Powder, Liq, caps SE: Some Liq dosage forms in sorbitol base (a cathartic); V/D, black stools, constipation Notes: Charcoal w/ sorbitol not OK in children <1 y; monitor for ↓ K+ & Mg2+; protect airway in lethargic/comatose pts Interactions: ↓ Effects if taken w/ ice cream, milk, sherbet; ↓ effects OF digoxin & absorption of other oral meds, ↓ effects OF syrup of ipecac NIPE: Most effective if given w/in 30 min of acute poisoning, only give to conscious patients Chloral Hydrate (Aquachloral, Supprettes) [C-IV] [Sedative/ Hypnotic/CNS Depressant] Uses: *Short-term nocturnal & preop sedation* Action: Sedative hypnotic; active metabolite trichloroethanol Dose: Adults. Hypnotic: 500 mg–1 g PO or PR 30 min hs or before procedure. Sedative: 250 mg PO or PR tid. Peds. Hypnotic: 20–50 mg/kg/24 h PO or PR 30 min hs or before procedure. Sedative: 5–15 mg/kg/dose q8h; avoid w/ CrCl <50 mL/min or severe hepatic impair Caution: [C, +] Porphyria & neonates, long-term care facility residents Contra: Allergy to components; severe renal, hepatic or cardiac Dz Disp: Caps 500 mg; syrup 250, 500 mg/5 mL; supp 324, 648 mg SE: GI irritation, drowsiness, ataxia, dizziness, nightmares, rash Interactions: ↑ Effects W/ antihistamines, barbiturates, paraldehyde, CNS depressants, opiate analgesics, EtOH; ↑ effects OF anticoagulants Labs:↑ Eosinophils, BUN; ↓ WBCs NIPE: N Take w/ EtOH, CNS depressants; N chew or crush caps; May accumulate; tolerance may develop >2 wk; taper dose; mix syrup in H2O or fruit juice Chlorambucil (Leukeran) [Antineoplastic/Alkylating Agent] WARNING: Myelosuppressive, carcinogenic, teratogenic, associated with infertility Uses: *CLL, Hodgkin Dz, Waldenström macroglobulinemia* Action: Alky- lating agent (nitrogen mustard) Dose: (Per protocol) 0.1–0.2 mg/kg/d for 3–6 wk or 0.4 mg/kg/dose q2wk Caution: [D, ?] Sz disorder & BM suppression; affects human fertility Contra: Previous resistance; alkylating agent allergy; w/ live vaccines Disp: Tabs 2 mg SE: ↓ BM, CNS stimulation, N/V, drug fever, rash, secondary leukemias, alveolar dysplasia, pulm fibrosis, hepatotox Interactions: ↑ BM suppression W/ antineoplastic drugs and immunosuppressants; ↑ risk of bleeding W/ ASA, anticoagulants Labs: ↑ Urine and serum uric acid, ALT, alkaline phosphatase; ↓ HMG, Hct, neutrophil, plts, RBCs, WBCs NIPE: N PRG, breast-feeding, Infxn; ↑ fluids to 2–3 L/d; monitor lab work periodically & CBC w/ differential weekly during drug use; may cause hair loss; ↓ dose if pt has received radiation Chlordiazepoxide (Librium, Mitran, Libritabs) [C-IV] [Anxi- olytic, Sedative/Hypnotic/Benzodiazepine] Uses: *Anxiety, tension, EtOH withdrawal*, & preop apprehension Action: Benzodiazepine; antianxiety agent Dose: Adults. Mild anxiety: 5–10 mg PO tid-qid or PRN. Severe anxiety: 25–50 mg IM, IV, or PO q6–8h or PRN. Peds >6 y. 0.5 mg/kg/24 h PO or Chlorpromazine 77

IM ÷ q6–8h; ↓ in renal impair, elderly Caution: [D, ?] Resp depression, CNS impair, h/o of drug dependence; avoid in hepatic impair Contra: Preexisting CNS depression, NAG Disp: Caps 5, 10, 25 mg; inj 100 mg SE: Drowsiness, CP, rash, fatigue, memory impair, xerostomia, wt gain Interactions: ↑ Effects W/ antidepressants, antihistamines, anticonvulsants, barbiturates, general anesthetics, MAOIs, narcotics, phenothiazines cimetidine, disulfiram, fluconazole, itraconazole, ketoconazole, OCPs, INH, metoprolol, propoxyphene, propranolol, valproic acid, EtOH, grapefruit juice, kava kava, valerian; ↑ effects OF digoxin, phenytoin; ↓ effects W/ aminophylline, antacids, carbamazepine, theophylline, rifampin, rifabutin, tobacco; ↓ effects OF levodopa Labs: ↑ LFTs, alkaline phosphatase, bilirubin, triglycerides; ↓ granulocytes NIPE: N EtOH, PRG, breast-feeding; risk of photosensitivity—use sunscreen, orthostatic hypotension, tachycardia; erratic IM absorption Chlorothiazide (Diuril) [Antihypertensive/Thiazide Diuretic] Uses: *HTN, edema* Action: Thiazide diuretic Dose: Adults. 500 mg–1 g PO daily-bid; 100–1000 mg/d IV (for edema only). Peds >6 mo. 20–30 mg/kg/24 h PO ÷ bid; 4 mg/kg/d IV; OK w/ food Caution: [D, +] Contra: Cross-sensitivity to thiazides/sulfonamides, anuria Disp: Tabs 250, 500 mg; susp 250 mg/5 mL; inj 500 mg/vial SE: ↓ K+, Na+, dizziness, hyperglycemia, hyperuricemia, hyperlipidemia, photosens Interactions: ↑ Effects W/ ACEI, amphotericin B, corticosteroids; ↑ effects OF diazoxide, Li, MTX; ↓ effects W/ colestipol, cholestyramine, NSAIDs; ↓ effects OF hypoglycemics Labs: ↑ CPK, ammonia, amylase, Ca2+, Cl–, cholesterol, glucose, Mg2+, K+, Na+, uric acid NIPE: Do not use IM/SQ; take early in the day to avoid nocturia; monitor for gout, hyperglycemia, photosensitivity—use sunscreen, I&O, weight Chlorpheniramine (Chlor-Trimeton, others) [OTC] [Antihista- mine/Propylamine] Uses: *Allergic rhinitis* common cold Action: Anti- histamine Dose: Adults. 4 mg PO q4–6h or 8–12 mg PO bid of SR Peds. 0.35 mg/kg/24 h PO ÷ q4–6h or 0.2 mg/kg/24 h SR Caution: [B, ?/–] BOO; NAG; hepatic insuff Contra: Allergy Disp: Tabs 4 mg; chew tabs 2 mg; SR tabs 8, 12 mg SE: Anticholinergic SE & sedation common, postural ↓ BP, QT changes, extrapyramidal Rxns, photosens Interactions: ↑ Effects W/ other CNS depressants, EtOH, opioids, sedatives, MAOIs, atropine, haloperidol, phenothiazines, quinidine, disopyramide; ↑ effects OF epinephrine; ↓ effects OF heparin, sulfonylureas Labs: False—w/ allergy testing NIPE: Stop drug 4 d prior to allergy testing, take w/ food if GI distress; do not cut/crush/chew ER forms; recent deaths in <2 y assoc w/ cough and cold meds [MMWR 2007 56(01):1–4] Chlorpromazine (Thorazine) [Antipsychotic, Antiemetic/ Phenothiazine] Uses: *Psychotic disorders, N/V*, apprehension, intractable hiccups Action: Phenothiazine antipsychotic; antiemetic Dose: Adults. Psychosis: 10–25 mg PO bid-tid (usual 30–800 mg/d in ÷ doses). Severe Sxs: 25 mg IM/IV initial; may repeat in 1–4 h; then 25–50 mg PO or PR tid. Hiccups: 25–50 mg PO bid-tid. Children >6 mo. Psychosis & N/V: 0.5–1 mg/kg/dose PO 78 Chlorpropamide q4–6h or IM/IV q6–8h Caution: [C, ?/-] Safety in children <6 mo not established; Szs, avoid w/ hepatic impair, BM suppression Contra: Cross-sensitivity w/ phenothiazines; NAG Disp: Tabs 10, 25, 50, 100, 200 mg; conc 30, 100 mg/mL; syrup 10 mg/5 mL; inj 25 mg/mL SE: Extrapyramidal SE & sedation; α-adrenergic blocking properties; ↓ BP; ↑ QT interval Interactions: ↑ Effects W/ amodiaquine, chloroquine, sulfadoxine–pyrimethamine, antidepressants, narcotic analgesics, propranolol, quinidine, BBs, MAOIs, TCAs, EtOH, kava kava; ↑ effects OF anticholinergics, centrally acting antihypertensives, propranolol, valproic acid; ↓ effects W/ antacids, antidiarrheals, barbiturates, Li, tobacco; ↓ effects OF anticonvulsants, guanethidine, levodopa, Li, warfarin Labs: False + urine bilirubin; false + or – PRG test; ↑alk phos, bilirubin, CK, GGT, eosinophil count; ↓ HMG, Hct, granulocytes, plts, WBC NIPE: Do not D/C abruptly; dilute PO conc in 2–4 oz of Liq; Risk of photosensitivity—use sunscreen; risk of tardive dyskinesia; take w/ food if GI upset; may darken urine Chlorpropamide (Diabinese) [Hypoglycemic/Sulfonylurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output Dose: 100–500 mg/d; w/ food, ↓ hepatic impairment Caution: [C, ?/–] CrCl <50 mL/min; ↓ in hepatic impair Con- tra: Cross-sensitivity w/ sulfonamides Disp: Tabs 100, 250 mg SE: HA, dizziness, rash, photosens, hypoglycemia, SIADH Interactions: ↑ Effects W/ ASA, NSAIDs, anticoagulants, BBs, chloramphenicol, guanethidine, insulin, MAOIs, rifampin, sulfonamides, EtOH, juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery, bitter melon, ginkgo biloba; ↓ effects W/ diazoxide, thiazide diuretics Labs: ↑ Alk phos, bilirubin, BUN, Cr, cholesterol; ↓ glucose HMG, Hct, plts, WBC NIPE: EtOH (disulfiram-like Rxn) Chlorthalidone (Hygroton, others) [Antihypertensive/Thiazide Diuretic] Uses: *HTN* Action: Thiazide diuretic Dose: Adults. 25–100 mg PO daily. Peds. (Not approved) 2 mg/kg/dose PO 3×/wk or 1–2 mg/kg/d PO; ↓ in renal impair; OK w/ food, milk Caution: [D, +] Contra: Cross-sensitivity w/ thiazides or sulfonamides; anuria Disp: Tabs 15, 25, 50 mg SE: ↓ K+, dizziness, photosens, hyperglycemia, hyperuricemia, sexual dysfunction Interactions: ↑ Effects W/ ACEIs, diazoxide; ↑ effects OF digoxin, Li, MTX; ↓ effects W/ cholestyramine, colestipol, NSAIDs; ↓ effects OF hypoglycemics; ↓ K+ W/ amphotericin B, carbenoxolone, corticosteroids Labs: ↑ Bilirubin, Ca2+, Cr, uric acid;↑ glucose in diabetics; ↓ Mg2+, K+, Na+ NIPE: May take w/ food, and milk, take early in day, use sunscreen; ↑ K+ rich foods in diet Chlorzoxazone (Paraflex, Parafon Forte DSC, others) [Skeletal Muscle Relaxant/ANS Drug] Uses: *Adjunct to rest & physical therapy to relieve discomfort associated w/ acute, painful musculoskeletal conditions* Action: Centrally acting skeletal muscle relaxant Dose: Adults. 250–500 mg PO tid-qid. Peds. 20 mg/kg/d in 3–4 ÷ doses Caution: [C, ?] Avoid EtOH & CNS depressants Contra: Severe liver Dz Disp: Tabs 250, 500 mg Ciclopirox 79

SE: Drowsiness, tachycardia, dizziness, hepatotox, angioedema Interactions: ↑ Effects W/ antihistamines, CNS depressants, MAOIs, TCAs, opiates, EtOH, water- cress Labs: ↑ Alk phos, bilirubin; monitor LFTs NIPE: Urine may turn reddish purple or orange Cholecalciferol [Vitamin D3] (Delta D) [Vitamin/Dietary Sup- plement] Uses: Dietary supl to Rx vitamin D deficiency Action: ↑ Intestinal Ca2+ absorption Dose: 400–1000 IU/d PO Caution: [A (D doses above the RDA), +] Contra: ↑ Ca2+, hypervitaminosis, allergy Disp: Tabs 400, 1000 IU SE: Vita- min D tox (renal failure, HTN, psychosis) Notes: 1 mg cholecalciferol = 40,000 IU vitamin D activity Interactions: ↑ Risk of arrhythmias W/ cardiac glycosides; ↓ effects W/ cholestyramine, colestipol, mineral oil, orlistat, phenobarbital, phenytoin Labs: ↑ BUN, Ca, cholesterol, Cr, LFTs, urine urea NIPE: Vitamin D is fat soluble; mineral oil interferes with vitamin D absorption; vitamin D is needed for Ca absorption Cholestyramine (Questran, Prevalite) [Antilipemic, Bile Acid Sequestrant] Uses: *Hypercholesterolemia; Rx pruritus associated w/ partial biliary obst; D associated w/ excess fecal bile acids* pseudomembranous colitis Action: Binds intestinal bile acids, forms insoluble complexes Dose: Adults. Titrate: 4 g/d-bid ↑ to max 24 g/d & 6 doses/d. Peds. 240 mg/kg/d in 3 ÷ doses Caution: [C, ?] Constipation, phenylketonuria Contra: Complete biliary or bowel obst; hypolipoproteinemia types III, IV, V Disp: 4 g of cholestyramine resin/9 g powder; w/ aspartame: 4 g resin/5 g powder (Light) 4 g resin/6.4 g powder SE: Constipation, abd pain, bloating, HA, rash Interactions: ↓ Effects OF acetaminophen, amiodarone, anticoagulants, ASA, cardiac glycosides, clindamycin, corticosteroids, diclofenac, fat-soluble vitamins, gemfibrozil, glipizide, Fe salts, MTX, methyldopa, nicotinic acid, penicillins, phenobarbital, phenytoin, propranolol, thiazide diuretics, tetracyclines, thyroid drugs, troglitazone, warfarin if given with this drug; Labs: ↑ Alkaline phosphatase, prothromin time;↓ cholesterol, folic acid, HMG, Hct NIPE: ↑ Fluids, take other drugs 1–2 h before or 6 h after; OD may cause GI obst; mix 4 g in 2–6 oz of noncarbonated beverage Ciclesonide (Omnaris) [Corticosteroid] Uses: Allergic rhinitis Ac- tion: Nasal corticosteroid Dose: Adults and Peds >12 y: 2 sprays each nostril 1 × d Caution: [C,?/–] w/ ketoconazole Contra: Component allergy Disp: Intranasal spray susp, 50 μg/spray, 120 doses SE: adrenal suppression, delayed nasal wound healing, URI, HA, ear pain, epistaxis NIPE: ↑ Risk viral Dz (eg, chickenpox), delayed growth in children Ciclopirox (Loprox, Penlac) [Antifungal/Antibiotic] Uses: *Tinea pedis, tinea cruris, tinea corporis, cutaneous candidiasis, tinea versicolor, tinea rubrum* Action: Antifungal antibiotic; cellular depletion of essential substrates &/or ions Dose: Adults & Peds >10 y. Massage into affected area bid. Ony- chomycosis: Apply to nails daily, with removal every 7 d Caution: [B, ?] Contra: Component sensitivity Disp: Cream 0.77%, gel 0.77%, topical sus 0.77%, shampoo 1%, 80 Cidofovir nail lacquer 8% SE: Pruritus, local irritation, burning Interactions: None noted NIPE: Nail lacquer may take 6 mo to see improvement; cream/gel/lotion see improvement by 4 wk; D/C w/ irritation; avoid dressings; gel best for athlete’s foot Cidofovir (Vistide) [Antiviral/Inhibits DNA synthesis] WARNING: Renal impair is the major tox. Follow administration instructions Uses: *CMV retinitis w/ HIV* Action: Selective inhibition of viral DNA synth Dose: Rx: 5 mg/kg IV over 1 h once/wk for 2 wk w/ probenecid. Maint: 5 mg/kg IV once/2 wk w/ probenecid (2 g PO 3 h prior to cidofovir, then 1 g PO at 2 h & 8 h after cidofovir); ↓ in renal impair Caution: [C, –] SCr >1.5 mg/dL or CrCl = 55 mL/min or urine protein >100 mg/dL; w/ other nephrotoxic drugs Contra: Probenecid or sulfa allergy Disp: Inj 75 mg/mL SE: Renal tox, chills, fever, HA, N/V/D, thrombocytopenia, neutropenia Interactions: ↑ Nephrotox W/ aminoglycosides, amphotericin B, foscarnet, IV pentamidine, NSAIDs, vancomycin; ↑ effects W/ zidovudine Labs: ↑ SCr, BUN, alkaline phosphatase, LFTs, urine protein; ↓ Ca, HMG, Hct, neutrophils, plts; monitor for hematuria, glycosuria, hypocalcemia, hyperglycemia, hypokalemia, hyperlipidemia NIPE: Coadminister oral probenecid w/ each dose to < GI upset; possible hair loss; hydrate w/ NS prior to each inf Cilostazol (Pletal) [Antiplatelet, Arterial Vasodilator/Phos- phodiesterase Inhibitor] Uses: *Reduce Sxs of intermittent claudica- tion* Action: Phosphodiesterase III inhibitor; ↑’s cAMP in plts & blood vessels, vasodilation & inhibit plt aggregation Dose: 100 mg PO bid, 1/2 h before or 2 h after breakfast & dinner Caution: [C, +/–] ↓ dose w/ drugs that inhibit CYP3A4 & CYP2C19 (Table 11) Contra: CHF, hemostatic disorders, active pathologic bleeding Disp: Tabs 50, 100 mg SE: HA, palpitation, D Interactions: ↑ Effects W/ diltiazem, macrolides, omeprazole, fluconazole, itraconazole, ketoconazole, sertraline, grapefruit juice; ↑ effects OF ASA; ↓ effects W/ cigarette smoking; Labs: ↑ HDL; ↓ triglycerides NIPE: Take on empty stomach; may take up to 12 wk to ↓ cramping pain; may cause dizziness Cimetidine (Tagamet) (Tagamet HB, Tagamet DS OTC) [Antiulcerative/H2-Receptor Antagonist] Uses: *Duodenal ulcer; ulcer prophylaxis in hypersecretory states, (eg, trauma, burns); & GERD* Action: H2-receptor antagonist Dose: Adults. Active ulcer: 2400 mg/d IV cont inf or 300 mg IV q6h; 400 mg PO bid or 800 mg hs. Maint: 400 mg PO hs. GERD: 300–600 mg PO q6h; maint 800 mg PO hs. Peds. Infants: 10–20 mg/kg/24 h PO or IV ÷ q6–12h. Children: 20–40 mg/kg/24 h PO or IV ÷ q6h; ↓ w/ renal insuff & in elderly Caution: [B, +] Many drug interactions (P-450 system) Contra: Compo- nent sensitivity Disp: Tabs 200, 300, 400, 800 mg; Liq 300 mg/5 mL; inj 300 mg/2 mL SE: Dizziness, HA, agitation, thrombocytopenia, gynecomastia Interactions: ↑ Effects OF benzodiazepines, disulfram, flecainide, INH, lidocaine, OCPs, sulfonylureas, warfarin, theophylline, phenytoin, metronidazole, triamterene, procainamide, quinidine, propranolol, diazepam, nifedipine, TCAs, procainamide, tacrine, carbamazepine, valproic acid, xanthines; ↓ effects W/ antacids, tobacco; ↓ effects OF digoxin, Ciprofloxacin, Otic 81 ketoconazole, cefpodoxime, indomethacin, tetracyclines Labs: ↑ Cr, LFTs; ↓ HMG, Hct, neutrophils, plt counts NIPE: Take w/ meals; monitor for gynecomastia, breast pain, impotence; take 1 h before or 2 h after antacids; avoid EtOH Cinacalcet (Sensipar) [Hyperparathyroidism Agent/Cal- cimimetic] Uses: *Secondary hyperparathyroidism in CRF; ↑ Ca2+ in parathyroid carcinoma* Action: ↓ PTH by ↑ Ca-sensing receptor sensitivity Dose: Secondary hyperparathyroidism: 30 mg PO daily. Parathyroid carcinoma: 30 mg PO bid; titrate q2–4wk based on Ca & PTH levels; swallow whole; take w/ food Caution: [C, ?/–] w/ seizures, adjust w/ CYP3A4 inhibitors (Table 11) Disp: Tabs 30, 60, 90 mg SE: N/V/D, myalgia, dizziness, ↓ Ca2+ Interactions: ↑ Effects W/ CYP3A4 inhibitors such as ketoconazole, itraconazole, erythromycine; ↑ effects OF drugs metabolized at CYP2D6 such as TCA, thioridazine, flecainide, vinblas- 2+ –2 tine Labs: Monitor Ca , PO4 , PTH NIPE: Must take drug with vitamin D and/or phosphate binders; ↑ concentrations of drug if taken w/ food Ciprofloxacin (Cipro, Cipro XR, Proquin XR) [Antibiotic/Fluo- roquinolone] Uses: *Rx lower resp tract, sinuses, skin & skin structure, bone/joints, & urinary tract Infxns including prostatitis* Action: Quinolone antibiotic; ↓ DNA gyrase. Spectrum: Broad gram(+) & (–) aerobics; little Streptococcus sp; good Pseudomonas sp, E. coli, B. fragilis, P. mirabilis, K. pneumoniae, C. jejuni, or Shigella sp Dose: Adults. 250–750 mg PO q12h; XR 500–1000 mg PO q24h; or 200–400 mg IV q12h; ↓ in renal impair Caution: [C, ?/–] Children <18 y Contra: Component sensitivity Disp: Tabs 100, 250, 500, 750 mg; tabs XR 500, 1000 mg; susp 5 g/100 mL, 10 g/100 mL; inj 200, 400 mg; premixed piggyback 200 mg/100 mL SE: Rest- lessness, N/V/D, rash, ruptured tendons, ↑ LFTs Interactions: ↑ Effects W/ probenecid; ↑ effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin; ↓ effects W/ antacids, didanosine, Fe salts, Mg, sucralfate, Na bicarbonate, Zn Labs: ↑ LFTs, alkaline phosphatase, serum bilirubin, LDH, BUN, SCr, K+, PT, triglycerides; ↓ plts, WBC NIPE: N Give to children <18 y; ↑ fluids to 2–3 L/d, may cause photosensitivity—use sunscreen; avoid antacids; reduce/restrict caffeine intake Ciprofloxacin, Ophthalmic (Ciloxan) [Antibiotic/Fluoro- quinolone Opthalmic Agent] Uses: *Rx & prevention of ocular Infxns (conjunctivitis, blepharitis, corneal abrasions)* Action: Quinolone antibiotic; ↓ DNA gyrase Dose: 1–2 gtt in eye(s) q2h while awake for 2 d, then 1–2 gtt q4h while awake for 5 d, oint 1/2" ribbon in eye 3 × d × 2 d, then 2 × d × 5 d Caution: [C, ?/–] Contra: Component sensitivity Disp: Soln 3.5 mg/mL; oint 0.3%, 35g SE: Local irritation Interactions: None reported NIPE: Limited systemic absorption Ciprofloxacin, Otic (Cipro HC Otic) [Antibiotic/Fluoro- quinolone Otic Agent] Uses: *Otitis externa* Action: Quinolone antibiotic; ↓ DNA gyrase Dose: Adult & Peds >1 mo. 1–2 gtt in ear(s) bid for 7 d Caution: [C, ?/–] Contra: Perforated tympanic membrane, viral Infxns of the external canal Disp: Susp ciprofloxacin 0.2% & hydrocortisone 1% SE: HA, pruritus NIPE: 1st-choice therapy for otitis externa 82 Cisplatin

Cisplatin (Platinol, Platinol AQ) [Antineoplastic/Alkylating Agent] Uses: *Testicular, SCLC, NSCLC, bladder, ovarian, breast, head & neck, & penile CAs; osteosarcoma; ped brain tumors* Action: DNA-binding; de- natures double helix; intrastrand cross-linking Dose: 10–20 mg/m2/d for 5 d q3wk; 50–120 mg/m2 q3–4wk; (per protocols); ↓ w/ renal impair Caution: [D, –] Cumu- lative renal tox may be severe; Mg2+, lytes before & w/in 48 h after cisplatin Contra: Platinum-containing compound allergy; ↓ BM, hearing impair, preexisting renal insuff Disp: Inj 1 mg/mL SE: Allergic Rxns, N/V, nephrotox (↑ w/ admin of other nephrotoxic drugs; minimize by NS inf & mannitol diuresis), high-frequency hearing loss in 30%, peripheral “stocking glove”-type neuropathy, cardiotox (ST, T-wave changes), ↓ Mg2+ , mild↓ BM, hepatotox; renal impair dose-related & cumulative Notes: Give taxanes before platinum derivatives Inter- actions: ↑ Effects OF antineoplastic drugs and radiation therapy; ↑ ototox W/ loop diuretics; ↑ nephrotox W/ aminoglycosides, amphotericin B, vancomycin; ↓ effects W/ Na thiosulfate; ↓ effects OF phenytoin Labs: ↑ BUN, Cr, serum bilirubin, AST, uric acid; ↓ Ca2+, Mg2+, phosphate, Na+, K+, RBC, WBC, plts NIPE: May cause infertility, N immunizations or products with ASA; instruct pt to report signs of Infxn and tinnitus Citalopram (Celexa) [Antidepressant/SSRI] WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in patients <24 y Uses: *Depression* Action: SSRI Dose: Initial 20 mg/d, may ↑ to 40 mg/d; ↓ in elderly & hepatic/renal insuff Caution: [C, +/–] h/o of mania, Szs & pts at risk for suicide Contra: MAOI or w/in 14 d of MAOI use Disp: Tabs 10, 20, 40 mg; dist tabs 10, 20, 40 mg; cap 10, 20, 40 mg; Soln 10 mg/5 mL SE: Somno- lence, insomnia, anxiety, xerostomia, diaphoresis, sexual dysfunction Notes: May cause ↓ Na+ /SIADH Interactions: ↑ Effects W/ azole antifungals, cimetidine, Li, macrolides, EtOH; ↑ effects OF BBs, carbamazepine, CNS drugs, warfarin; ↓ effects W/ carbamazepine; ↓ effects OF phenytoin; may cause fatal Rxn W/ MAOIs Labs: ↑ LFTs NIPE: N PRG, breast-feeding, use barrier contraception Cladribine (Leustatin) [Antineoplastic Agent/Purine Nucleo- side Analog] Uses: *HCL, CLL, NHLs, progressive MS* Action: Induces DNA strand breakage; interferes w/ DNA repair/synth; purine nucleoside analog Dose: 0.09–0.1 mg/kg/d cont IV inf for 1–7 d (Per protocols) Caution: [D, ?/–] Causes neutropenia & Infxn Contra: Component sensitivity Disp: Inj 1 mg/mL SE: ↓ BM, T-lymphocyte ↓ may be prolonged (26–34 wk), fever in 46%, tumor lysis synd, Infxns (especially lung & IV sites), rash (50%), HA, fatigue Interac- tions: ↑ Risk of bleeding W/ anticoagulants, NSAIDs, salicylates, ↑ risk of nephrotox W/ amphotericin B Labs: Monitor CBC, LFTs, SCr NIPE: N PRG, breast-feeding; consider prophylactic allopurinol Clarithromycin (Biaxin, Biaxin XL) [Antibiotic/Macrolide] Uses: *Upper/lower resp tract, skin/skin structure Infxns, H. pylori Infxns, & In- fxns caused by nontuberculosis (atypical) Mycobacterium sp; prevention of MAC Clindamycin 83

Infxns in HIV-Infxn* Action: Macrolide antibiotic, ↓ protein synth. Spectrum: H. influenzae, M. catarrhalis, S. pneumoniae, M. pneumoniae, & H. pylori Dose: Adults. 250–500 mg PO bid or 1000 mg (2 × 500 mg XR tab)/d. Mycobacterium: 500 mg PO bid. Peds >9 mo. 7.5 mg/kg/dose PO bid; ↓ in renal/hepatic impair Caution: [C, ?] Antibiotic-associated colitis; rare QT prolongation & ventricular arrhythmias, including torsades de pointes Contra: Macrolide allergy; w/ ranitidine in pts w/ h/o of porphyria or CrCl <25 mL/min Disp: Tabs 250, 500 mg; susp 125, 250 mg/5 mL; 500, 1000 mg XR tab SE: ↑QT interval, causes metallic taste, N/D, abd pain, HA, rash Interactions: ↑ Effects W/ amprenavir, indinavir, nelfinavir, ritonavir; ↑ effects OF atorvastatin, buspirone, clozapine, colchicine, diazepam, felodipine, itraconazole, lovastatin, simvastatin, methylprednisolone, theophylline, phenytoin, quinidine, digoxin, carbamazepine, triazolam, warfarin, ergotamine, alprazolam, valproic acid; ↓ effects W/ EtOH; ↓ effects OF penicillin, zafirlukast Labs: ↑ Serum AST, ALT, GTT, alkaline phosphatase, LDH, total bilirubin, BUN, Cr, PT, INR; ↓ WBC NIPE: May take w/ food; do not refrigerate susp & discard >14 d Clemastine Fumarate (Tavist, Dayhist, Antihist-1) [OTC] [An- tihistamine] Uses: *Allergic rhinitis & Sxs of urticaria* Action: Antihista- mine Dose: Adults & Peds. >12 y: 1.34 mg bid–2.68 mg tid; max 8.04 mg/d. <6 y: 0.335–0.67 mg/d ÷ into (max 1.34 mg/d) 2–3 d. 6–12 y: 0.67–1.34 mg bid (max 4.02 /d) Caution: [C, M] BOO; Do not take w/ MAOI Contra: NAG Disp: Tabs 1.34, 2.68 mg; syrup 0.67 mg/5 mL SE: Drowsiness, dyscoordination, epigastric distress, urinary retention Notes: Avoid EtOH Interactions: ↑ Effects W/ CNS depressants, MAOIs, EtOH; ↓ effects OF heparin, sulfonylureas Clindamycin (Cleocin, Cleocin-T, Others) [Antibiotic/Lincomycin Derivative] WARNING: Pseudomembranous colitis may range from mild to life threatening Uses: *Rx aerobic & anaerobic Infxns; topical for severe acne & vaginal Infxns* Action: Bacteriostatic; interferes w/ protein synth. Spectrum: Streptococci sp, Pneumococci sp, Staphylococci sp, & gram(+) & (–) anaerobes; no activity against gram(–) aerobes Dose: Adults. PO: 150–450 mg PO q6–8h. IV: 300–600 mg IV q6h or 900 mg IV q8h. Vaginal: 1 applicator hs for 7 d. Topical: Apply 1% gel, lotion, or soln bid. Peds. Neonates: (Avoid use; contains benzyl alcohol) 10–15 mg/kg/24 h ÷ q8–12h. Children >1 mo: 10–30 mg/kg/24 h ÷ q6–8h, to a max of 1.8 g/d PO or 4.8 g/d IV. Topical: Apply 1%, gel, lotion, or soln bid; ↓ in severe hepatic impair Caution: [B, +] Can cause fatal colitis Contra: h/o pseudomembranous colitis Disp: Caps 75, 150, 300 mg; susp 75 mg/5 mL; inj 300 mg/2 mL; vaginal cream 2%, topical sol 1%, gel 1%, lotion 1%, vaginal supp 100 mg SE: D may be C. difficile pseudomembranous colitis, rash, ↑ LFTs Interactions: ↑ Effects of neuromuscular blockage W/ tubocurarine, pancuronium; ↓ effects W/ erythromycin, kaolin, foods w/ sodium cyclamate Labs: Monitor CBC, LFTs, BUN, Cr; ↓ WBC,plts NIPE: D/C drug w/ D, eval for C. difficile; N intercourse, tampons, douches while using vaginal cream; take oral meds w/ 8 oz water 84 Clofarabine

Clofarabine (Clolar) [Antineoplastic; Purine Nucleoside An- timetabolite] Uses: Rx relapsed/refractory ALL after at least 2 regimens in children 1–21 y Action: Antimetabolite; ↓ ribonucleotide reductase w/ false nucleotide base-inhibiting DNA synth Dose: 52 mg/m2 IV over 2 h daily × 5 d (repeat q2–6wk); per protocol Caution: [D, –] Disp: Inj 20 mg/20 mL SE: N/V/D, anemia, leukopenia, thrombocytopenia, neutropenia, Infxn Interactions: ↑ Additive risk W/ hepatotoxic or nephrotoxic drugs Labs: ↑ AST, ALT, Cr, HMG, Hct NIPE: Pts at risk for tumor lysis synd—monitor serum uric acid, phosphate, Ca & Cr bid for 2–3 d after starting chemotherapy; monitor for systemic inflammatory response synd (SIRS)/capillary leak synd; hydrate well Clonazepam (Klonopin) [C-IV] [Anticonvulsant/Benzodi- azepine] Uses: *Lennox-Gastaut synd, akinetic & myoclonic Szs, absence Szs, panic attacks*, restless legs synd, neuralgia, parkinsonian dysarthria, bipolar disorder Action: Benzodiazepine; anticonvulsant Dose: Adults. 1.5 mg/d PO in 3 ÷ doses; ↑ by 0.5–1 mg/d q3d PRN up to 20 mg/d. Peds. 0.01–0.03 mg/kg/24 h PO ÷ tid; ↑ to 0.1–0.2 mg/kg/24 h ÷ tid; avoid abrupt D/C Caution: [D, M] Elderly pts, resp Dz, CNS depression, severe hepatic impair, NAG Contra: Severe liver Dz, acute NAG Disp: Tabs 0.5, 1, 2 mg, Oral disintegrating tabs 0.125, 0.25, 0.5, 1, 2 mg SE: CNS side effects, including drowsiness, dizziness, ataxia, memory impair Interactions: ↑ CNS depression W/ antidepressants, antihistamines, opiates, benzodiazepines; ↑ effects W/ cimetidine, disulfiram, fluoxetine, INH, itraconazole, ketoconazole, metoprolol, valproic acid, EtOH, kava kava, valerian; ↓ effects W/ phenytoin Labs: ↑ LFTs, ↓ WBC, plts NIPE: N D/C abruptly; can cause retrograde amnesia; a CYP3A4 substrate Clonidine, Oral (Catapres) [Antihypertensive/Centrally Act- ing Sympatholytic] Uses: *HTN*; opioid, EtOH, & tobacco withdrawal Action: Centrally acting α-adrenergic stimulant Dose: Adults. 0.1 mg PO bid, adjust daily by 0.1–0.2-mg increments (max 2.4 mg/d). Peds. 5–10 μgμg/kg/d ÷ q8–12h (max 0.9 mg/d); ↓ in renal impair Caution: [C, +/–] Avoid w/ β-blocker Contra: Component sensitivity Disp: Tabs 0.1, 0.2, 0.3 mg SE: drowsiness, orthostatic ↓ BP, xerostomia, constipation, bradycardia, dizziness Interactions: ↑ Seda- tion W/ CNS depressants; ↓ antihypertensive effects W/ amphetamines, BB, MAOIs TCA Labs:↑ Glucose NIPE: More effective for HTN if combined w/ diuretics; withdraw slowly, rebound HTN w/ abrupt D/C of doses >0.2 mg bid Clonidine, Transdermal (Catapres TTS) [Antihypertensive/ Centrally Acting Sympatholytic] Uses: *HTN* Action: Centrally acting α-adrenergic stimulant Dose: 1 patch q7d to hairless area (upper arm/torso); titrate to effect; ↓ w/ severe renal impair Caution: [C, +/–] Avoid w/ β-blocker, withdraw slowly Contra: Component sensitivity Disp: TTS-1, TTS-2, TTS-3 (delivers 0.1, 0.2, 0.3 mg, respectively, of clonidine/d for 1 wk) SE: Drowsiness, orthostatic ↓ BP, xerostomia, constipation, bradycardia Interactions: ↑ Sedation W/ CNS depressants; ↓ antihypertensive effects W/ amphetamines, BB, MAOIs TCA Clotrimazole 85

Labs: ↑ Glucose, CK NIPE: Do not D/C abruptly (rebound HTN) Doses >2 TTS- 3 usually not associated w/ ↑ efficacy; steady state in 2–3 d Clopidogrel (Plavix) [Antiplatelet/Platelet Aggregation In- hibitor] Uses: *Reduce atherosclerotic events*, administer ASAP in ECC setting w/ high risk ST depression or T wave inversion Action: ↓ Plt aggregation Dose: 75 mg/d; 300–600 mg PO × 1 dose can be used to load pts; 300 mg PO, then 75 mg daily 1–9 mo (ECC 2005) Caution: [B, ?] Active bleeding; risk of bleeding from trauma & other; TTP; liver Dz Contra: Coagulation disorders, active/or intracranial bleeding; CABG planned w/in 5–7 d Disp: Tabs 75 mg SE: ↑ Bleeding time, GI intolerance, HA, dizziness, rash, thrombocytopenia Interactions: ↑ Risk of GI bleed W/ ASA, NSAIDs, heparin, warfarin, feverfew, garlic, ginger, ginkgo biloba; ↑ effects OF phenytoin, tamoxifen, tolbutamide Labs: ↑ LFTs; ↓ plts, WBC; NIPE: D/C drug 1 wk prior to surgery; plt aggregation to baseline 5 d after D/C, plt transfusion to reverse acutely Clorazepate (Tranxene) [C-IV] [Anxiolytic, Anticonvul- sant, Sedative/Hypnotic/Benzodiazepine] Uses: *Acute anxiety disorders, acute EtOH withdrawal Sxs, adjunctive therapy in partial Szs* Action: Benzodiazepine; antianxiety agent Dose: Adults. 15–60 mg/d PO single or ÷ doses. Elderly & debilitated pts: Initial 7.5–15 mg/d in ÷ doses. EtOH withdrawal: Day 1: Initial 30 mg; then 30–60 mg ÷ doses; Day 2: 45–90 mg ÷ doses; Day 3: 22.5–45 mg ÷ doses; Day 4: 15–30 mg ÷ doses. Peds. 3.75–7.5 mg/dose bid to 60 mg/d max ÷ bid-tid Caution: [D, ?/–] Elderly; h/o depression Contra: NAG; not OK <9 y of age Disp: Tabs 3.75, 7.5, 15 mg; Tabs-SD (daily) 11.25, 22.5 mg SE: CNS depressant effects (drowsiness, dizziness, ataxia, memory impair), ↓ BP Interactions: ↑ Effects W/ antidepressants, antihistamines, barbiturates, MAOIs, opiates, phenothiazines, cimetidine, disulfiram, EtOH; ↓ effects OF levodopa; ↓ effects W/ rifampin, ginkgo, tobacco Labs: ↓ Alk phosp; monitor pts w/ renal/hepatic impair (drug may accumulate) NIPE: N D/C abruptly; may cause dependence Clotrimazole (Lotrimin, Mycelex, Others) [OTC] [Antifungal] Uses: *Candidiasis & tinea Infxns* Action: Antifungal; alters cell wall permeability. Spectrum: Oropharyngeal candidiasis, dermatophytoses, superficial mycoses, cutaneous candidiasis, & vulvovaginal candidiasis Dose: PO: Prophylaxis: One troche dissolved in mouth tid Rx: One troche dissolved in mouth 5 × d for 14 d. Vaginal 1% cream: 1 applicator full hs for 7 d. 2% cream: 1 applicator full hs for 3 d Tabs: 100 mg vaginally hs for 7 d or 200 mg (2 tabs) vaginally hs for 3 d or 500-mg tabs vaginally hs once. Topical: Apply bid 10–14 d Caution: [B, (C if PO), ?] Not for systemic fungal Infxn; safety in children <3 y not established Con- tra: Component allergy Disp: 1% cream; soln; lotion; troche 10 mg; vaginal tabs 100, 500 mg; vaginal cream 1%, 2% SE: Topical: Local irritation; PO: N/V Inter- actions: ↑ Effects of cyclosporine, tacrolimus; ↓ effects of spermicides Labs: ↑ LFTs NIPE: PO prophylaxis immunosuppressed pts 86 Clotrimazole & Betamethasone

Clotrimazole & Betamethasone (Lotrisone) [Antifungal, Anti-inflammatory] Uses: *Fungal skin Infxns* Action: Imidazole antifungal & anti-inflammatory. Spectrum: Tinea pedis, cruris, & corpora Dose: Pts = 17 y: Apply & massage into area bid for 2–4 wk Caution: [C, ?] Varicella Infxn Contra: Children <12 y Disp: Cream 15, 45 g; lotion 30 mL SE: Local irritation, rash NIPE: Not for diaper dermatitis or under occlusive dressings Clozapine (Clozaril & FazaClo) [Antipsychotic/Dibenzodi- azepine Derivative] WARNING: Myocarditis, agranulocytosis, Szs, & orthostatic ↓ BP associated w/ clozapine; ↑ mortality in elderly w/ dementia- related psychosis Uses: *Refractory severe schizophrenia*; childhood psychosis Action: “Atypical” TCA Dose: 25 mg daily-bid initial; ↑ to 300–450 mg/d over 2 wk; maint lowest dose possible; do not D/C abruptly Caution: [B, +/–] Monitor for psychosis & cholinergic rebound Contra: Uncontrolled epilepsy; comatose state; WBC <3500 cells/mm3 and ANC <2000 cells/mm3 before Rx or <3000 cells/mm3 during Rx Disp: Orally disint tabs 25 mg, 100 mg; tabs 25, 100 mg SE: Sialorrhea, tachycardia, drowsiness, ↑ wt, constipation, incontinence, rash, Szs, CNS stimulation, hyperglycemia Notes: Avoid activities where sudden loss of consciousness could cause harm; benign temperature ↑ may occur during the 1st 3 wk of Rx, weekly CBC mandatory 1st 6 mo, then qowk Interactions: ↑ Effects W/ clarithromycin, cimetidine, erythromycin, fluoxetine, paroxetine, quinidine, sertraline; ↑ depressant effects W/ CNS depressants, EtOH; ↑ effects OF digoxin, warfarin; ↓ effects W/ carbamazepine, phenytoin, primidone, phenobarbital, valproic acid, St. John’s Wort, nutmeg, caffeine; ↓ effects OF phenytoin Labs: Monitor WBCs NIPE: ↑ Risk of developing agranulocytosis Cocaine [C-II] [Narcotic analgesic] Uses: *Topical anesthetic for mucous membranes* Action: Narcotic analgesic, local vasoconstrictor Dose: Lowest topical amount that provides relief; 1 mg/kg max Caution: [C, ?] Contra: PRG Disp: Topical soln & viscous preparations 4–10%; powder SE: CNS stimulation, nervousness, loss of taste/smell, chronic rhinitis, CV tox, abuse potential Inter- actions: ↑ Effects W/ MAOIs, ↑ risk of HTN & arrhythmias W/ epinephrine NIPE: Use only on PO, laryngeal, & nasal mucosa; do not use on extensive areas of broken skin Codeine [C-II] [Analgesic, Antitussive/Opioid] Uses: *Mild- moderate pain; symptomatic relief of cough* Action: Narcotic analgesic; ↓ cough reflex Dose: Adults. Analgesic: 15–20 mg PO or IM qid PRN. Antitussive: 10–20 mg PO q4h PRN; max 120 mg/d. Peds. Analgesic: 0.5–1 mg/kg/dose PO q4–6h PRN. Antitussive: 1–1.5 mg/kg/24 h PO ÷ q4h; max 30 mg/24 h. Max: 60 mg/dose; ↓ in renal/hepatic impair Caution: [C, (D if prolonged use or high dose at term), +] Contra: Component sensitivity Disp: Tabs 15, 30, 60 mg; soln 15 mg/5 mL; inj 15, 30 mg/mL SE: Drowsiness, constipation, ↓ BP Notes: 120 mg IM = 10 mg IM morphine Interactions: ↑ CNS depression W/ CNS depressants, antidepressants, MAOIs, TCAs, barbiturates, benzodiazepines, muscle relaxants, phenothiazines, Conivaptan HCL 87 cimetidine, antihistamines, sedatives, EtOH; ↑ effects OF digitoxin, phenytoin, rifampin; ↓ effects W/ nalbuphine, pentazocine, tobacco Labs: ↑ amylase, lipase, ↑ urine morphine NIPE: Usually combined w/ APAP for pain or w/ agents (eg, terpin hydrate) as an antitussive Colchicine [Antigout Agent/Colchicum Alkaloid] Uses: *Acute gouty arthritis & prevention of recurrences; familial Mediterranean fever*; primary biliary cirrhosis Action: ↓ migration of leukocytes; ↓ leukocyte lactic acid production Dose: Initial: 0.6–1.2 mg PO, then 0.6 mg q1–2h until relief or GI SE develop (max 8 mg/d); do not repeat for 3 d. IV: 1–3 mg, then 0.5 mg q6h until relief (max 4 mg/d); do not repeat for 7 d. Prophylaxis: PO: 0.6 mg/d or 3–4 d/wk; ↓ renal impair Caution: [D, +] Elderly Contra: Serious renal, GI, hepatic, or cardiac disorders; blood dyscrasias Disp: Tabs 0.6 mg; inj 1 mg/2 mL SE: N/V/D, abd pain, BM suppression, hepatotox; local Rxn w/ SQ/IM Notes: Colchicine 1–2 mg IV w/in 24–48 h of an acute attack diagnostic/therapeutic in monoarticular arthritis Interactions: ↑ Risk of leukopenia W/ phenylbutazone; ↓ effects W/ loop diuret- ↓ ↑ ↓ ics; effects OF vitamin B12 Labs: Alk phos, ALT, AST; cholesterol, HMG, Hct, plts; false + urine Hgb & RBCs NIPE: N EtOH Colesevelam (WelChol) [Antilipemic/Bile Acid Sequestrant] Uses: *Reduction of LDL & total cholesterol alone or in combo w/ an HMG-CoA reductase inhibitor* Action: Bile acid sequestrant Dose: 3 tabs PO bid w/ meals Caution: [B, ?] Severe GI motility disorders; in patients w/ triglycerides >300 mg/dL (may ↑ levels); use not established in peds Contra: Bowel obst Disp: Tabs 625 mg SE: Constipation, dyspepsia, myalgia, weakness Interactions: ↓ Vitamin absorption Labs: Monitor lipids NIPE: Take w/ food and Liq; may ↓ absorption of fat-soluble vitamins Colestipol (Colestid) [Antilipemic/Bile Acid Sequestrant] Uses: *Adjunct to ↓ serum cholesterol in primary hypercholesterolemia, relieve pruritus associate with ↑ bile acids* Action: Binds intestinal bile acids to form insoluble complex Dose: Granules: 5–30 g/d ÷ 2–4 doses; Tabs: 2–16 g/d daily-bid Caution: [C, ?] Avoid w/ high triglycerides, GI dysfunction Contra: Bowel obst Disp: Tabs 1 g; granules 5, 7.5, 300, 450, 500 g SE: Constipation, abd pain, bloating, HA Interactions: ↓ Absorption OF numerous drugs especially anticoagulants, cardiac glycosides, digitoxin, digoxin, phenobarbital, penicillin G, tetracycline, thiazide diuretics, thyroid drugs Labs: ↑ Alk phos; PT prolonged NIPE: Take other meds 1 h before or 4 h after colestipol; do not use dry powder; mix w/ beverages, cereals, etc; may ↓ absorption of other medications and fat- soluble vitamins Conivaptan HCL (Vaprisol) [Hyponatremic Agent/Vaso- pressin Receptor Antagonist] Uses: Euvolemic hyponatremia Action: × Dual arginine vasopressin V1A/V2 receptor antagonist Dose: 20 mg IV 1 over 30 min, then 20 mg cont IV inf over 24 h; 20 mg/d cont IV inf for 1–3 more d; may ↑ to 40 mg/d if Na+ not responding; 4 d max use; use large vein, change site q24h 88 Copper IUD Contraceptive

Caution: [C; ?/–] Rapid ↑ Na+ (>12 mEq/L/24 h) may cause osmotic demyelina- tion synd; impaired renal/hepatic Fxn; may ↑ digoxin levels; CYP3A4 inhibitor (Table 11) Contra: Hypovolemic hyponatremia; w/ CYP3A4 inhibitors Disp: Am- pule 20 mg/4 mL SE: Inf site Rxns, HA, N/V/D, constipation, ↓ K+, orthostatic ↓ BP, thirst, dry mouth, pyrexia, pollakiuria, polyuria, Infxn Interactions: ↑ Effects OF amlodipine, digoxin, midazolam, simvastatin, & CYP3A4 inhibitors such as clarithromycin, itraconazole, ketoconazole, ritonavir Labs: May ↑ digoxin level; ↓ K+, Na+, Mg2+; monitor Na+; D/C w/ very rapid ↑ Na+ NIPE: Monitor volume and neurologic status; mix only w/ 5% dextrose; D/C w/ very rapid ↑ Na+; monitor Na+, volume and neurologic status Copper IUD Contraceptive (ParaGard T 380A) [Contraceptive] Uses: *Contraception, long-term (up to 10 y)* Action: ?, Interfere w/ sperm survival/ transport Dose: Insert any time during menstrual cycle; replace @ 10 y max Cau- tion: [C, ?] Remove w/ intrauterine PRG, increased risk of comps w/ PRG and device in place Contra: Acute PID or in high-risk behavior, postpartum endometritis, cervicitis Disp: 52 mg IUD SE: PRG, ectopic PRG, pelvic Infxn immunocompro- mise, embedment, perforation expulsion, Wilson Dz, fainting w/ insert, vaginal bleeding, expulsion NIPE: Counsel patient does not protect against STD/HIV; see insert for detailed instructions; 99% effective Cortisone See Steroids, and Tables 3 & 4 Cromolyn Sodium (Intal, NasalCrom, Opticrom, others) [Antiasthmatic/Mast Cell Stabilizer] Uses: *Adjunct to the Rx of asthma; prevent exercise-induced asthma; allergic rhinitis; ophth allergic manifestations*; food allergy Action: Antiasthmatic; mast cell stabilizer Dose: Adults & Children >12 y: Inhal: 20 mg (as powder in caps) inhaled qid or met-dose inhaler 2 puffs qid. PO: 200 mg qid 15–20 min ac, up to 400 mg qid. Nasal instillation: Spray once in each nostril 2–6 × /d. Ophth: 1–2 gtt in each eye 4–6 × d. Peds. Inhal: 2 puffs qid of met-dose inhaler. PO: Infants <2 y: (Not OK) 20 mg/kg/d in 4 ÷ doses. 2–12 y: 100 mg qid ac Caution: [B, ?] Contra: Acute asthmatic attacks Disp: PO conc 100 mg/5 mL; soln for neb 20 mg/2 mL; met-dose inhaler; nasal soln 40 mg/mL; ophth soln 4% SE: Unpleasant taste, hoarseness, coughing Inter- actions: None noted Labs: Monitor pulmonary Fxn tests NIPE: No benefit in acute Rx; 2–4 wk for max effect in perennial allergic disorders Cyanocobalamin [Vitamin B12] (Nasocobal) [Vitamin B/Dietary Supplement] Uses: *Pernicious anemia & other vitamin B12 deficiency states; ↑ requirements due to PRG; thyrotoxicosis; liver or kidney Dz* Action: Di- μ μ etary vitamin B12 supl Dose: Adults. 100 g g IM or SQ daily; intranasal: 500 μgμg once/wk for pts in remission, for 5–10 d, then 100 μg IM 2 × /wk for 1 mo, then 100 μg IM monthly. Peds. Use 0.2 μg/kg × 2 d test dose; if OK 30–50 μg/d/M for 2 or more wk (total 10 μg) then maint 100 mg/mo Caution: [A (C if dose ex- ceeds RDA), +] Contra: Allergy to cobalt; hereditary optic nerve atrophy; Leber Dz Disp: Tabs 50, 100, 250, 500, 1000, 2500, 5000 μg; inj 100, 1000 μg/mL; Cyclopentolate with Phenylephrine 89 intranasal (Nasocobal) gel 500 μg/0.1 mL SE: Itching, D, HA, anxiety Interac- ↓ tions: Effects due to malabsorption of B12 W/ aminosalicylic acid, aminoglycosides, chloramphenicol, EtOH Labs: ↓ K+ levels NIPE: PO absorption erratic and not recommended; OK for use w/ hyperalimentation Cyclobenzaprine (Flexeril) [Skeletal Muscle Relaxant/ANS Agent] Uses: *Relief of muscle spasm* Action: Centrally acting skeletal muscle relaxant; reduces tonic somatic motor activity Dose: 5–10 mg PO bid-qid (2–3 wk max) Caution: [B, ?] Shares the toxic potential of the TCAs; urinary hesitancy, NAG Contra: Do not use concomitantly or w/in 14 d of MAOIs; hyperthyroidism; heart failure; arrhythmias Disp: Tabs 5, 7.5, 10 mg SE: Sedation & anticholinergic effects Interactions: ↑ Effects of CNS depression W/ CNS depressants, TCAs, barbiturates, EtOH; ↑ risk of HTN & convulsions W/ MAOIs NIPE: ↑ Fluids & fiber for constipation; may inhibit mental alertness or physical coordination Cyclobenzaprine, extended release (Amrix) [Skeletal Mus- cle Relaxant/ANS Agent] Uses: *Muscle spasm* Action: ? Centrally acting long-term muscle relaxant Dose: 15–30 mg PO daily 2–3 wk; 30 mg/d max Caution: [B, ?/–] w/ urinary retention, NAG, w/ EtOH/CNS depressant Contra: MAOI w/in 14 d, elderly, arrhythmias, heart block, CHF, MI recovery phase, ↑thyroid Disp: Caps 15, 30 ER SE: Dry mouth, drowsiness, dizziness, HA, N, blurred vision, dysgeusia Interactions: ↑ Effects of CNS depression W/ CNS depressants, TCAs, barbiturates, EtOH; ↑ risk of HTN & convulsions W/ MAOIs NIPE: ↑ Flu- ids & fiber constipation; may inhibit mental alertness or physical coordination; avoid abrupt D/C w/ long-term use Cyclopentolate ophthalmic (Cyclogyl, Cylate) [Anticholiner- gic/Cycloplegic Mydriatic Agent] Uses: *Cycloplegia, mydriasis* Action: Cycloplegic mydriatic, anticholinergic inhibits iris sphincter and ciliary body Dose: Adults. 1 gtt in eye 40–50 min preprocedure, may repeat × 1 in 5–10 min Peds. As adult, children 0.5–1.0%; infants use 0.5% Caution: [C (may cause late-term fetal anoxia/bradycardia), +/–], Premature infants HTN, Down synd, elderly, Contra: NAG Disp: Ophth soln 0.5, 1, 2% SE: Tearing, HA, irritation, eye pain, photophobia, arrhythmia, tremor, ↑ IOP, confusion Interactions: ↓ Effects OF carbachol, cholinesterase inhibitors, pilocarpine NIPE: Burning sensation when instilled; compress lacrimal sac for several min after dose; heavily pigmented irises may require ↑ strength; peak 25–75 min, cycloplegia 6–24 h, mydriasis up to 24 h; 2% soln may result in psychotic Rxns and behavioral disturbances in peds Cyclopentolate with Phenylephrine (Cyclomydril) [Anti- cholinergic/Cycloplegic Mydriatic, Alpha-Adrenergic Ago- nist] Uses: * Action: Cycloplegic mydriatic, α-adrenergic agonist w/ anticholinergic to inhibit iris sphincter Dose: 1 gtt in eye q5–10min (max 3 doses) 40–50 min preprocedure Caution: [C (may cause late-term fetal anoxia/bradycardia), +/–] HTN, w/ elderly w/ CAD, Contra: NAG Disp: Ophth soln cyclopentolate 0.2%/phenlephrine 1% (2, 5 mL) SE: Tearing, HA, irritation, eye pain, photophobia, 90 Cyclophosphamide arrhythmia, tremor NIPE: Compress lacrimal sac for several min after dose; heavily pigmented irises may require ↑ strength; peak 25–75 min, cycloplegia 6–24 h, mydriasis up to 24 h Cyclophosphamide (Cytoxan, Neosar) [Antineoplastic/ Alkylating Agent] Uses: *Hodgkin Dz & NHLs; multiple myeloma; small- cell lung, breast, & ovarian CAs; mycosis fungoides; neuroblastoma; retinoblas- toma; acute leukemias; allogeneic & ABMT in high doses; severe rheumatologic disorders* Action: Converted to acrolein & phosphoramide mustard, the active alkylating moieties Dose: (Per protocol) 500–1500 mg/m2; single dose at 2- to 4-wk intervals; 1.8 g/m2 to 160 mg/kg (or @ 12 g/m2 in 75-kg individual) in the BMT setting (per protocols); ↓ renal impair Caution: [D, ?] w/ BM suppression, hepatic insuff Contra: Component sensitivity Disp: Tabs 25, 50 mg; inj 500 mg, 1g, 2g SE: ↓ BM; hemorrhagic cystitis, SIADH, alopecia, anorexia; N/V; hepatotox; rare interstitial pneumonitis; irreversible testicular atrophy possible; cardiotox rare; 2nd malignancies (bladder, ALL), risk 3.5% at 8 y, 10.7% at 12 y Interactions: ↑ Effects W/ allopurinol, cimetidine, phenobarbital, rifampin; ↑ effects OF succinylcholine, warfarin; ↓ effects OF digoxin Labs: May ↑ uric acid level; ↓ HMG, Hct, plts, RBC, WBCs NIPE: May cause sterility, hair loss, N PRG, breast-feeding, immunizations; hemorrhagic cystitis prophylaxis: continuous bladder irrigation & mesna uroprotection; encourage hydration, long-term bladder Ca screening Cyclosporine (Sandimmune, NeOral, Gengraf) [Immuno- suppressant/Polypeptide Antibiotic] WARNING: ↑ Risk neoplasm, ↑ risk skin malignancies, ↑ risk HTN and nephrotox Uses: *Organ rejection in kidney, liver, heart, & BMT w/ steroids; RA; psoriasis* Action: Im- munosuppressant; reversible inhibition of immunocompetent lymphocytes Dose: Adults & Peds. PO: 15 mg/kg/d 12 h pretransplant; after 2 wk, taper by 5 mg/wk to 5–10 mg/kg/d. IV: If NPO, give 1/3 PO dose IV; ↓ in renal/hepatic impair Cau- tion: [C, ?] Dose-related risk of nephrotox/hepatotox; live, attenuated vaccines may be less effective Contra: Renal impair; uncontrolled HTN Disp: Caps 25, 50, 100 mg; PO soln 100 mg/mL; inj 50 mg/mL SE: May ↑ BUN & Cr & mimic transplant rejection; HTN; HA; hirsutism Notes: Levels: Trough: Just before next dose. Thera- peutic: Variable 150–300 ng/mL (RIA) Interactions: ↑ Effects W/ azole antifungals, allopurinol, amiodarone, anabolic steroids, CCBs, cimetidine, chloroquine, clarithromycin, clonidine, diltiazem, macrolides, metoclopramide, nicardipine, NSAIDs, OCPs, ticlopidine, grapefruit juice; ↑ nephrotox W/ aminoglycosides, amphotericin B, acyclovir, colchicine, enalapril, ranitidine, sulfonamides; ↑ risk OF digoxin tox; ↑ risk of hyperkalemia W/ diuretics, ACEIs; ↓ effects W/ barbiturates, carbamazepine, INH, nafcillin, pyrazinamide, phenytoin, rifampin, sulfonamides, St. John’s Wort, alfalfa sprouts, astragalus, echinacea, licorice; ↓ effects OF immunizations Labs: ↑ SCr, BUN, LFTs, LDL,glucose; ↓ HMG, plts, WBCs NIPE: Monitor for hyperglycemia, hyperkalemia, hyperuricemia, risk of photosensitivity—use sunscreen; administer in glass container; NeOral & Sandimmune not interchangeable Cytarabine Liposome 91

Cyclosporine ophthalmic (Restasis) [Immunosuppressant/ Anti-inflammatory] Uses: *↑ Tear production suppressed due to ocular inflammation* Action: Immune modulator, anti-inflammatory Dose: 1 gtt bid each eye 12 h apart; OK w/ artificial tears, allow 15 min between Caution: [C, –] Con- tra: Ocular Infxn, component allergy Disp: Single-use vial 0.05% SE: Ocular burning/hyperemia NIPE: N Children <16 y; may insert contact lenses 15 min after installation; mix vial well Cyproheptadine (Periactin) [Antihistamine, Antipruritic] Uses: *Allergic Rxns; itching* Action: Phenothiazine antihistamine; serotonin antagonist Dose: Adults. 4–20 mg PO ÷ q8h; max 0.5 mg/kg/d. Peds. 2–6 y: 2 mg bid-tid (max 12 mg/24 h). 7–14 y: 4 mg bid-tid; ↓ in hepatic impair Caution: [B, ?] BPH Contra: Neonates or <2 y; NAG; BOO; acute asthma; GI obst Disp: Tabs 4 mg; syrup 2 mg/5 mL SE: Anticholinergic, drowsiness Interactions: ↑ Effects W/ CNS depressants, MAOIs, EtOH; ↓ effects OF epinephrine, fluoxetine Labs: False—allergy skin testing NIPE: ↑ Risk photosensitivity—use sunscreen, take w/ food if GI distress; may stimulate appetite Cytarabine [ARA-C] (Cytosar-U) [Antineoplastic/Antimetabo- lite] WARNING: Administration by experienced physician in properly equipped facility; potent myelosuppressive agent Uses: *Acute leukemias, CML, NHL; IT for leukemic meningitis or prophylaxis* Action: Antimetabolite; interferes w/ DNA synth Dose: 100–150 mg/m2/d for 5–10 d (low dose); 3 g/m2 q12h for 8–12 doses (high dose); 1 mg/kg 1–2/wk (SQ maint); 5–70 mg/m2 up to 3/wk IT (per protocols); ↓ in renal/hepatic impair Caution: [D, ?] w/ marked BM suppression, ↓ dosage by ↓ the number of days of administration Contra: Component sensitivity Disp: Inj 100, 500 mg, 1, 2 g also 20, 100 mg/mL SE: ↓ BM, N/V/D, stomatitis, flulike Sx, rash on palms/soles, hepatic/cerebellar dysfunction, noncar- diogenic pulm edema, neuropathy, fever Interactions: ↓ Effects OF digoxin, flucytosine Labs: ↑ Uric acid, ↓ HMG, Hct, plts, RBCs, WBCs NIPE: N EtOH, NSAIDs, ASA, PRG, breast-feeding, immunizations; little use in solid tumors; high-dose tox limited by corticosteroid ophth soln Cytarabine Liposome (DepoCyt) [Antineoplastic/Antimetabo- lite] WARNING: Can cause chemical arachnoiditis (N/V/HA, fever) ↓ severity w/ dexamethasone. Administer by experienced physician in properly equipped facility Uses: *Lymphomatous meningitis* Action: Antimetabolite; interferes w/ DNA synth Dose: 50 mg IT q14d for 5 doses, then 50 mg IT q28d × 4 doses; use dexamethasone prophylaxis Caution: [D, ?] May cause neurotox; blockage to CSF flow may ↑ the risk of neurotox; use in peds not established Contra: Active meningeal Infxn Disp: IT inj 50 mg/5 mL SE: Neck pain/rigidity, HA, confusion, somnolence, fever, back pain, N/V, edema, neutropenia, ↓ plt, anemia Interactions: ↓ Effects OF digoxin, flucytosine Labs: ↑ Uric acid, ↓ HMG, Hct, plts, RBCs, WBCs NIPE: N EtOH, NSAIDs, ASA, PRG, breast-feeding, immunizations; cytarabine liposomes are similar in microscopic appearance to WBCs; caution in interpreting CSF studies 92 Cytomegalovirus Immune Globulin

Cytomegalovirus Immune Globulin [CMV-IG IV] (CytoGam) [Immune Globulin] Uses: *Attenuation CMV Dz associated w/ transplantation* Action: Exogenous IgG antibodies to CMV Dose: 150 mg/kg/dose w/in 72 h of transplant, for 16 wk posttransplant; see insert Caution: [C, ?] Anaphylactic Rxns; renal dysfunction Contra: Allergy to immunoglobulins; IgA deficiency Disp: Inj 50 mg/mL SE: Flushing, N/V, muscle cramps, wheezing, HA, fever In- teractions: ↓ Effects OF live virus vaccines NIPE: IV only; administer by separate line; do not shake; administer immunizations at least 3 mo after CMV-IG Dacarbazine (DTIC) [Antineoplastic/Alkylating Agent] WARNING: Causes hematopoietic depression, hepatic necrosis, may be carcinogenic, teratogenic Uses: *Melanoma, Hodgkin Dz, sarcoma* Action: Alkylating agent; antimetabolite as a purine precursor; ↓ protein synth, RNA, & especially DNA Dose: 2–4.5 mg/kg/d for 10 consecutive d or 250 mg/m2/d for 5 d (Per protocols); ↓ in renal impair Caution: [C, ?] In BM suppression; renal/hepatic impair Contra: Component sensitivity Disp: Inj 100, 200, 500 mg SE: ↓ BM, N/V, hepatotox, flulike Sx, ↓ BP, photosens, alopecia, facial flushing, facial paresthesias, urticaria, phlebitis at inj site Interactions: ↑ Risk of bleeding W/ anticoagulants, ASA; ↓ effects W/ phenobarbital, phenytoin Labs: ↑ AST, ALT; ↓ plts, RBCs, WBCs NIPE: Risk of photosensitivity—use sunscreen, hair loss, Infxn; avoid extravasation Daclizumab (Zenapax) [Immunosuppressant/Immunomod- ulator] WARNING: Administer under skilled supervision in equipped facility Uses: *Prevent acute organ rejection* Action: IL-2 receptor antagonist Dose: 1 mg/kg/dose IV; 1st dose pretransplant, then 4 doses 14 d apart post-transplant Caution: [C, ?] Contra: Component sensitivity Disp: Inj 5 mg/mL SE: Hyper- glycemia, edema, HTN, ↓ BP, constipation, HA, dizziness, anxiety, nephrotox, pulm edema, pain, anaphylaxis/hypersensivity; Interactions: ↑ Risk of mortality W/ corticosteroids, cyclosporine, mycophenolate mofetil; NIPE: N Immuniza- tions, Infxns, ↑ fluid intake; Administer w/in 4 h of preparation Dactinomycin (Cosmegen) [Antineoplastic/Antibiotic] WARNING: Administer under skilled supervision in equipped facility; powder and soln toxic, corrosive, mutagenic, carcinogenic, & teratogenic, avoid exposure and use precautions Uses: *Choriocarcinoma, Wilms tumor, Kaposi and Ewing sarcoma, rhabdomyosarcoma, uterine and testicular CA* Action: DNA intercalating agent Dose: Adult: 0.5 mg/d for 5 d; 2 mg/wk for 3 consecutive wk; 15 μg/kg or 0.45 mg/m2/d (max 0.5 mg) for 5 d q3–8wk Peds: Sarcoma (per protocols); ↓ in renal impair Caution: [C, ?] Contra: Concurrent/recent chickenpox or herpes zoster; infants <6 mo Disp: Inj 0.5 mg SE: Myelo/immunosuppression, severe N/V, alopecia, acne, hyperpigmentation, radiation recall phenomenon, tissue damage w/ extrav, hepatotox Interactions: ↑ Effects of BM suppressants, radiation therapy; ↓ effects of vitamin K Labs: Monitor CBC; ↓ HMG, Hct, plts, RBCs, WBCs NIPE: N PRG, breast-feeding; risk of irreversible infertility, reversible hair loss, ↑ fluids to 2–3 L/d Dapsone, Oral 93

Dalteparin (Fragmin) [Anticoagulant/Low Molecular Weight Heparin] WARNING: ↑ Risk of spinal/epidural hematoma with LP Uses: *Unstable angina, non-Q-wave MI, prevention of ischemic comps due to clot formation in pts on concurrent ASA, prevent & Rx DVT following surgery* Action: LMW heparin Dose: Angina/MI: 120 units/kg (max 10,000 units) SQ q12h w/ ASA. DVT prophylaxis: 2500–5000 units SC 1–2 h preop, then daily for 5–10 d. Systemic anticoagulation: 200 units/kg/d SQ or 100 units/kg bid SQ Cau- tion: [B, ?] In renal/hepatic impair, active hemorrhage, cerebrovascular Dz, cerebral aneurysm, severe HTN Contra: HIT; pork product allergy; w/ mifepristone Disp: Inj 2500 units (16 mg/0.2 mL), 5000 units (32 mg/0.2 mL), 7500 units (48 mg/0.3 mL), 10,000 units (64 mg/mL), 25,000 units/mL (3.8 mL); prefilled vials: 10,000 units/mL (9.5 mL) SE: Bleeding, pain at site, ↓ plt Interactions: ↑ Bleeding W/ oral anticoagulants, plt inhibitors, warfarin, garlic, ginger, ginkgo biloba, ginseng, chamomile Labs: ↑ AST, ALT; monitor CBC & plts NIPE: N Give IM or IV; administer Subq OK route only Dantrolene (Dantrium) [Skeletal Muscle Relaxant/Hydan- toin Derivative] WARNING: Hepatotox reported; D/C after 45 d if no benefit observed Uses: *Rx spasticity due to upper motor neuron disorders (eg, spinal cord injuries, stroke, CP, MS); malignant hyperthermia* Action: Skeletal muscle relaxant Dose: Adults. Spasticity: 25 mg PO daily; ↑ 25 mg to effect to 100 mg max PO qid PRN. Peds. 0.5 mg/kg/dose bid; ↑ by 0.5 mg/kg to effect, to 3 mg/kg/dose max qid PRN. Adults & Peds. Malignant hyperthermia: Rx: Continuous rapid IV, start 1 mg/kg until Sxs subside or 10 mg/kg is reached. Postcrisis F/U: 4–8 mg/kg/d in 3–4 ÷ doses for 1–3 d to prevent recurrence Caution: [C, ?] Impaired cardiac/pulm Fxn Contra: Active hepatic Dz; where spasticity needed to maintain posture or balance Disp: Caps 25, 50, 100 mg; powder for inj 20 mg/vial SE: Hepa- totox, ↑ LFTs, drowsiness, dizziness, rash, muscle weakness, D/N/V pleural effusion w/ pericarditis, D, blurred vision, hepatitis Interactions: ↑ Effects W/ CNS depressants, antihistamines, opiates, EtOH; ↑ risk of hepatotox W/ estrogens; ↑ risk of CV collapse & ventricular fib W/ CCBs; ↓ plasma protein binding W/ clofibrate, warfarin Labs: ↑ LFTs NIPE: ↑ Risk of photosensitivity—use sunscreen; N EtOH Dapsone, Oral [Antileprotic, Antimalarial] Uses: *Rx & prevent PCP; toxoplasmosis prophylaxis; leprosy* Action: Unknown; bactericidal Dose: Adults. PCP prophylaxis 50–100 mg/d PO; Rx PCP 100 mg/d PO w/ TMP 15–20 mg/kg/d for 21 d. Peds. PCP prophylaxis alternated dose: (>1 mo) 4 mg/kg/dose once/wk (max 200 mg); Prophylaxis of PCP 1–2 mg/kg/24 h PO daily; max 100 mg/d Caution: [C, +] G6PD deficiency; severe anemia Contra: Component sensitivity Disp: Tabs 25, 100 mg SE: Hemolysis, methemoglobinemia, agranulocytosis, rash, cholestatic jaundice Notes: Absorption ↑ by an acidic environment; for leprosy, combine w/ rifampin & other agents Interactions: ↑ Effects W/ probenecid, trimethoprim; ↓ effects W/ activated charcoal, rifampin Labs: Monitor CBC, LFTs NIPE: ↑ Risk of photosensitivity—use sunscreen 94 Dapsone, topical

Dapsone, topical (Aczone) [Antileprotic, Antimalarial] Uses: *Topical for acne vulgaris* Action: Unknown; bactericidal Dose: Apply pea-sized amount and rub into areas BID; wash hands after Caution: [C, +] G6PD deficiency; severe anemia Contra: Component sensitivity Disp: 5% gel SE: Skin oiliness/peeling, dryness erythema Labs: Monitor CBC; check G6PD levels and monitor G6PD if deficient NIPE: Not for oral, ophthalmic, or intravag use Daptomycin (Cubicin) [Antibiotic/Cyclic Lipopeptide Antibac- terial] Uses: *Complicated skin/skin structure Infxns due to gram(+) organisms* S. aureus, bacteremia, right-sided MSA, MRSA endocarditis Action: Cyclic lipopeptide; rapid membrane depolarization & bacterial death. Spectrum: S. aureus (including MRSA), S. pyogenes, S. agalactiae, S. dysgalactiae subsp Equisimilis & E. faecalis (vancomycin-susceptible strains only) Dose: Bacteremia: 4 mg/kg IV daily × 7–14 d (over 30 min); 6mg/kg IV daily for 2–6 wk; Endocarditis: 6 mg/kd q 48; ↓ w/ CrCl < 30 mL/min/ or Dialysis: 4 mg/kg q48h Caution: [B, ?] w/ HMG- CoA inhibitors Disp: Inj 250, 500 mg/10 mL SE: Anemia, constipation, N/V/D, HA, rash, site Rxn, muscle pain/weakness, edema, cellulitis, hypo/hyperglycemia, ↑ alkaline phosphatase, cough, back pain, abd pain, ↓ K+, anxiety, chest pain, sore throat, cardiac failure, confusion, Candida Infxns Notes: Consider D/C HMG-CoA reductase inhibitors to ↓ myopathy risk Interactions: ↑ Effects OF anticoagulants; ↓ effects OF tobramycin; ↓ effects W/ tobramycin Labs: monitor CPK baseline and weekly, LFTs, PT, INR; ↑ alkaline phosphatase, CPK, LFTs; ↓ HMG, Hct, K+ NIPE: Monitor for pseudomembranous colitis; safety & efficacy not established in pts <18 y Darbepoetin Alfa (Aranesp) [Antianemic/Hematopoietic] WARNING: Associated with ↑ CV, thromboembolic events and/or mortality; D/C if HB >12 g/dL; may increase tumor progression and death in cancer patients Uses: *Anemia associated w/ CRF*, anemia in nonmyeloid malignancy w/ concurrent chemo Action: ↑ Erythropoiesis, recombinant erythropoietin variant Dose: 0.45 μg/kg single IV or SQ qwk; titrate, do not exceed target Hgb of 12 g/dL; use lowest doses possible, see insert to convert from Epogen Caution: [C, ?] May ↑ risk of CV &/or neurologic SE in renal failure; HTN; w/ h/o Szs Contra: Uncontrolled HTN, component allergy Disp: 25, 40, 60, 100, 200, 300, μg/mL, 150 μg/0.075 mL in polysorbate or albumin excipient SE: May ↑ cardiac risk, CP, hypo/hypertension, N/V/D, myalgia, arthralgia, dizziness, edema, fatigue, fever, ↑ risk Infxn Interac- tions: None noted Labs: Monitor weekly CBC until stable NIPE: Longer 1/2-life than Epogen; monitor BP & for Sz activity, shaking vial inactivates drug Darifenacin (Enablex) [Antispasmodic/Anticholinergic] Uses: *OAB* Urinary antispasmodic, Action: Muscarinic receptor antagonist Dose: 7.5 mg/d PO; 15 mg/d max (7.5 mg/d w/ moderate hepatic impair or w/ CYP3A4 inhibitors); w/ drugs metabolized by CYP2D) (Table 11); swallow whole Caution: [C, ?/–] w/ hepatic impair Contra: Urinary/gastric retention, uncontrolled NAG, paralytic ileus Disp: Tabs ER 7.5 mg, 15 mg SE: Xerostomia/eyes, constipation, dyspepsia, abd pain, retention, abnormal vision, dizziness, asthenia Daunorubicin 95

Interactions: ↑ Effects W/ clarithromycin, itraconazole, ketoconazole, ritonavir, nelfinavir, ↑ effects OF digoxin, flecainide, TCAs, thioridazine Labs: Monitor LFTs NIPE: Take W/ or W/O food & swallow whole; drug will relieve symptoms but not treat cause; may cause heat prostration d/t < sweating Darunavir (Prezista) [Antiretroviral/Protease Inhibitor] Uses: *Rx HIV w/ resistance to multiple protease inhibitors* Action: HIV-1 protease inhibitor Dose: 600 mg PO BID, administer w/ ritonavir 100 mg BID Caution: [B, ?/–] h/o sulf allergy, CYP3A4 substrate, increase or decrease levels of many medications Contra: w/ astezole, terfadine, dihydroergotamine, er- gonovine, ergotamine, methylergonovine, pimozide, midazolam, triazolam Sup- plied: Tabs 300 mg SE: Central redistribution of fat (metabolic synd), N Interactions: ↑ Effects OF amiodarone, atorvastatin, bepridil, clarithromycin, cyclosporine, dihydropyridine, felodipine, HMG-CoA reductase inhibitors (statins), itraconazole, ketoconazole, lidocaine, nifedipine, pravastatin, quinidine, sildenafil, tacrolimus, trazodone, vardenafil; ↓ effects W/ carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, efavirenz, St. John’s Wort; ↓ effects OF methadone, rifampin, SSRI, trazodone, warfarin Labs: ↑ Amylase, glucose; cholesterol, triglycerides, LFTs, uric acid; ↓ WBCs, neutrophils NIPE: Administer w/ ritonavir and food Dasatinib (Sprycel) [Antineoplastic/Protein-Tyrosin Kinase Inhibitor] Uses: CML, Ph + ALL Action: Multi tyrosine kinase inhibitor Dose: 70 mg PO bid; adjust w/ CYP3A inhibitors/inducers (Table 11) Caution: [D, ?/–] Contra: None Disp: Tabs 20, 50, 70 mg SE: ↓ BM, edema, fluid retention, pleural effusions, N/V/D, abd pain, bleeding, fever, ↑ QT Interactions: ↑ Ef- fects W/ atazanavir, clarithromycin, erythromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin; ↓ effects W/ antacids, carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampicin, St. John’s Wort Labs: ↑ LFTs, Cr, uric acid, troponin levels; ↓ plts, RBC, neutrophils; monitor CBC weekly for 2 mo, then monthly NIPE: N Chew or crush tabs Daunorubicin (Daunomycin, Cerubidine) [Antineoplastic/ Anthracycline] WARNING: Cardiac Fxn should be monitored due to potential risk for cardiac tox & CHF, renal/hepatic dsfxn Uses: *Acute leukemias* Action: DNA intercalating agent; ↓ topoisomerase II; generates oxygen free radicals Dose: 45–60 mg/m2/d for 3 consecutive d; 25 mg/m2/wk (per protocols); ↓ in renal/hepatic impair Caution: [D, ?] Contra: Component sensitivity Disp: Inj 20, 50 mg SE: ↓ BM, mucositis, N/V, alopecia, radiation recall phenomenon, hepatotox (hyperbilirubinemia), tissue necrosis w/ extrav, cardiotox (1–2% CHF w/ 550 mg/m2 cumulative dose) Notes: Prevent cardiotox w/ dexrazoxane (when pt received >300 mg/m of daunorubicin cum dose); for IV use only; admin allopurinol prior to ↓ risk of hyperuricemia Interactions: ↑ Risk of cardiotox W/ cyclophosphamide; ↑ myelosuppression W/ antineoplastic agents; ↓ response to live virus vaccines Labs: ↓ Neutrophils, plts NIPE: N ASA, NSAIDs, EtOH, PRG, breast- feeding, immunizations; risk of hair loss 96 Decitabine

Decitabine (Dacogen) Uses: *MDS* Action: Inhibits DNA methyltransferase Dose: 15 mg/m2 cont inf over 3 h; repeat q8h × 3 d; repeat cycle q6wk, min 4 cycles; delay Tx and ↓ dose if inadequate hematologic recovery at 6 wk (see label protocol) Caution: [D, ?/–]; avoid PRG; males should not father a child during or 2 mo after; renal/hepatic impair Disp: Powder 50 mg/vial SE: Neutropenia, febrile neutropenia, thrombocytopenia, anemia, leukopenia, peripheral edema, petechiae, N/V/D, constipation, stomatitis, dyspepsia, cough, fever, fatigue, ↑ LFTs & bili, hyperglycemia, Infxn, HA Labs: ↑ LFTs, bili, glucose; check CBC and plt before each cycle & PRN NIPE: May premedicate w/ antiemetic; N PRG; males should not father a child during or 2 mo after use Delavirdine (Rescriptor) [Antiretroviral/NNRTI] Uses: *HIV Infxn* Action: Nonnucleoside RT inhibitor Dose: 400 mg PO tid Caution: [C, ?] CDC recommends HIV-infected mothers not to breast-feed (transmission risk); w/ renal/hepatic impair Contra: Use w/ drugs dependent on CYP3A for clearance (Table 11) Disp: Tabs 100, 200 mg SE: Fat redistribution, immune reconstitution synd, HA, fatigue, rash, ↑ transaminases, N/V/D Interactions: ↑ Ef- fects W/ fluoxetine; ↑ effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfenadine, triazolam, warfarin; ↓ effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin; ↓ effects OF didanosine Labs: ↑ AST, ALT, ↓ HMG, Hct, plts, neutrophil counts, WBC NIPE: Take w/o regard to food Deferasirox (Exjade) [Iron Chelator] Uses: *Chronic iron overload due to transfusion in patients >2 y* Action: Oral iron chelator Dose: Initial: 20 mg/kg PO/d; adjust by 5–10 mg/kg q3–6mo based on monthly ferritin; 30 mg/kg/d max; on empty stomach 30 min before food; hold dose if ferritin <500 μg/L, dissolve in water, orange, apple juice (<1 g/3.5 oz; >1 g in 7 oz) drink immediately; resuspend residue and swallow; do not chew, swallow whole tabs or take w/ Al-containing antacids Caution: [B, ?/–] Disp: Tabs for oral susp 125, 250, 500 mg SE: N/V/D, abd pain, skin rash, HA, fever, cough, Infxn, hearing loss, dizziness, cataracts, retinal disorders, ↑ IOP, lens opacities, dizziness Notes: ARF, peripheral cytopenia possible Labs: ↑ Cr, LFTs; Cr weekly 1st mo then Q month, monitor CBC; monthly Cr, urine protein, LFTs NIPE: Do not combine w/ other iron chelator therapies; dose to nearest whole tablet; auditory and ophthalmic testing initially and q12 mo Demeclocycline (Declomycin) [Antibiotic] Uses: *SIADH* Ac- tion: Antibiotic, antagonizes ADH action on renal tubules Dose: 300–600 mg PO q12h on empty stomach; ↓ in renal failure; avoid antacids Caution: [D, +] Avoid in hepatic/renal impair & children Contra: Tetracycline allergy Disp: Tabs 150, 300 mg SE: D, abd cramps, photosens, DI Interactions: Effects OF digoxin, anticoagulants; ↓ effects W/ antacids, Bi salts, Fe, Na bicarbonate, barbiturates, Desmopressin 97 carbamazepine, hydantoins, food; ↓ effects OF OCPs, penicillin Labs: False— urine glucose; monitor CBC, LFTs, BUN, Cr NIPE: Risk of photosensitivity—use sunscreen & avoid sunlight Desipramine (Norpramin) [Antidepressant/TCA] WARNING: Closely monitor for worsening depression or emergence of suicidality Uses: *En- dogenous depression*, chronic pain, peripheral neuropathy Action: TCA; ↑ synaptic serotonin or norepinephrine in CNS Dose: 75–200 mg/d single or ÷ dose; usually single hs dose (max 300 mg/d); ↓ dose in elderly Caution: [C, ?/–] CV Dz, Sz disorder, hypothyroidism Contra: MAOIs w/in 14 d; during AMI recovery phase Disp: Tabs 10, 25, 50, 75, 100, 150 mg; caps 25, 50 mg SE: Anticholinergic (blurred vision, urinary retention, xerostomia); orthostatic ↓ BP; ↑ QT interval, arrhythmias Interactions: ↑ Effects W/ cimetidine, diltiazem, fluoxetine, indinavir, MAOIs, paroxetine, propoxyphene, quinidine, ritonavir ranitidine, EtOH, grapefruit juice; ↑ effects OF Li, sulfonylureas; ↓ effects W/ barbiturates, carbamazepine rifampin, tobacco NIPE: Full effect of drug may take 4 wk; blue-green urine; risk of photosensitivity—use sunscreen Desloratadine (Clarinex) [Antihistamine/Selective H1- Receptor Antagonist] Uses: *Seasonal & perennial allergic rhinitis; chronic idiopathic urticaria* Action: Active metabolite of Claritin, H1-antihistamine, blocks inflammatory mediators Dose: Adults & Peds >12 y: 5 mg PO daily; 5 mg PO qod w/ hepatic/renal impair Caution: [C, ?/–] RediTabs contain phenylalanine; safety not established for <12 y Disp: Tabs & RediTabs (rapid dissolving) 5 mg, syrup 0.5 mg/mL SE: Allergy, anaphylaxis, somnolence, HA, dizziness, fatigue, pharyngitis, xerostomia, N, dyspepsia, myalgia Labs: ↑ LFTs, bilirubin NIPE: Take w/o regard to food Desmopressin (DDAVP, Stimate) [Antidiuretic/Hormone] Uses: *DI (intranasal & parenteral); bleeding due to uremia, hemophilia A, & type I von Willebrand Dz (parenteral), nocturnal enuresis* Action: Synthetic analog of vasopressin (human ADH); ↑ factor VIII Dose: DI: Intranasal: Adults. 0.1–0.4 mL (10–40 μg/d in 1–3 ÷ doses). Peds 3 mo–12 y: 0.05–0.3 mL/d in 1 or 2 doses. Par- enteral: Adults. 0.5–1 mL (2–4 μg/d in 2 ÷ doses); converting from nasal to parenteral, use 1/10 nasal dose. PO: Adults. 0.05 mg bid; ↑ to max of 1.2 mg. Hemophilia A & von Willebrand Dz (typeI): Adults & Peds >10 kg: 0.3 μg/kg in 50 mL NS, inf over 15–30 min. Peds <10 kg. As above w/ dilution to 10 mL w/ NS. Nocturnal enuresis: Peds >6 y: 20 μg intranasally hs Caution: [B, M] Avoid overhydration Contra: Hemophilia B; CrCl <50 mL/min, severe classic von Willebrand Dz; pts w/ factor VIII antibodies Disp: Tabs 0.1, 0.2 mg; inj 4, 15 μg/mL; nasal soln 0.1, 1.5 mg/mL SE: Facial flushing, HA, dizziness, vulval pain, nasal congestion, ↓ + ↑ pain at inj site, Na , H2O intox Interactions: Antidiuretic effects W/ carbamazepine, chlorpropamide, clofibrate; ↑ effects OF vasopressors; ↓ antidiuretic effects W/ demeclocycline, Li, norepinephrine NIPE: Monitor I&O, N EtOH, ↓ ↓ + overhydration; in very young & old pts, fluid intake to avoid H2O intox & Na 98 Dexamethasone, Nasal

Dexamethasone, Nasal (Dexacort Phosphate Turbinaire) [Anti-inflammatory, Immunosuppressant/Glucocorticoid] Uses: *Chronic nasal inflammation or allergic rhinitis* Action: Anti-inflammatory corticosteroid Dose: Adult & Peds >12 y: 2 sprays/nostril bid-tid, max 12 sprays/d. Peds 6–12 y: 1–2 sprays/nostril bid, max 8 sprays/d Caution: [C, ?] Contra: Un- treated Infxn Disp: Aerosol, 84 μg/activation SE: Local irritation NIPE: Use decongestant nose gtt 1st if nasal congestion Dexamethasone, Ophthalmic (AK-Dex Ophthalmic, Decadron Ophthalmic) [Anti-inflammatory, Immunosuppressant/ Glucocorticoid] Uses: *Inflammatory or allergic conjunctivitis* Action: Anti-inflammatory corticosteroid Dose: Instill 1–2 gtt tid-qid Caution: [C, ?/–] Contra: Active untreated bacterial, viral, & fungal eye Infxns Disp: Susp & soln 0.1%; oint 0.05% SE: Long-term use associated w/ cataracts NIPE: Eval intraocular pressure and lens if prolonged use Dexamethasone Systemic, Topical (Decadron) [Anti-inflammatory, Immunosuppressant/Glucocorticoid] See Steroids, Systemic, & Tables 3 and 4; Interactions: ↑ Effects W/ cyclosporine, estrogens, OCPs, macrolides; ↑ effects OF cyclosporine; ↓ effects W/ aminoglutethimide, antacids, barbiturates, carbamazepine, cholestyramine, colestipol, phenytoin, phenobarbital, rifampin; ↓ effects OF anticoagulants, hypoglycemics, INH, toxoids, salicylates, vaccines Labs: False—allergy skin tests NIPE: N Vaccines, breast- feeding, use on broken skin Dexpanthenol (Ilopan-Choline PO, Ilopan) [Cholinergic] Uses: *Minimize paralytic ileus, Rx postop distention* Action: Cholinergic agent Dose: Adults. Relief of gas: 2–3 tabs PO tid. Prevent postop ileus: 250–500 mg IM stat, repeat in 2 h, then q6h PRN. Ileus: 500 mg IM stat, repeat in 2 h, then q6h, PRN Caution: [C, ?] Contra: Hemophilia, mechanical bowel obst Disp: Inj 250 mg/mL; tabs 50 mg; cream 2% SE: GI cramps NIPE: Monitor BP during IV administration Dexrazoxane (Zinecard) [Chelating Agent] Uses: *Prevent anthracycline-induced (eg, doxorubicin) cardiomyopathy* Action: Chelates heavy metals; binds intracellular iron & prevents anthracycline-induced free radicals Dose: 10:1 ratio dexrazoxane:doxorubicin 30 min prior to each dose, 5:1 ratio w/ CrCl <40 mL/min Caution: [C, ?] Contra: Component sensitivity Disp: Inj powder 250, 500 mg (10 mg/mL) SE: ↓ BM (esp. leukopenia), fever, Infxn, stomatitis, alopecia, N/V/D Interactions: ↑ Length of muscle relaxation W/ succinylcholine Labs: Mild ↑ transaminase; NIPE: inj site pain Dextran 40 (Rheomacrodex, Gentran 40) [Plasma Volume Expander; Glucose Polymer] Uses: *Shock, prophylaxis of DVT & thromboembolism, adjunct in peripheral vascular surgery* Action: Expands plasma volume; ↓ blood viscosity Dose: Shock: 10 mL/kg inf rapidly; 20 mL/kg max 1st 24 h; beyond 24 h 10 mL/kg max; D/C after 5 d. Prophylaxis of DVT & thromboembolism: 10 mL/kg IV day of surgery, then 500 mL/d IV for 2–3 d, then Diazepam 99

500 mL IV q2–3d based on risk for up to 2 wk Caution: [C, ?] Inf Rxns; w/ corticosteroids Contra: Major hemostatic defects; cardiac decompensation; renal Dz w/ severe oliguria/anuria Disp: 10% dextran 40 in 0.9% NaCl or 5% dextrose SE: Allergy/anaphylactoid Rxn (observe during 1st min of inf), arthralgia, cutaneous Rxns, ↓ BP, fever Interactions: ↑ Bleeding times W/ antiplt agents or anticoagulants Labs: Monitor Cr & lytes; ↑ ALT, AST NIPE: Draw blood before administration of drug; pt should be well hydrated prior to inf Dextromethorphan (Mediquell, Benylin DM, PediaCare 1, Delsym, others) [OTC] [Antitussive] Uses: *Control nonproductive cough* Action: Suppresses medullary cough center Dose: Adults. 10–30 mg PO q4h PRN (max 120 mg/24 h). Peds. 2–6 y: 2.5–7.5 mg q4–8h (max 30 mg/24 h). 7–12 y: 5–10 mg q4–8h (max 60 mg/24/h) Caution: [C, ?/–] Not for persistent or chronic cough contra: (2 y) Disp: Caps 30 mg; lozenges 2.5, 5, 7.5, 15 mg; syrup 15 mg/15 mL, 10 mg/5 mL; Liq 10 mg/15 mL, 3.5, 7.5, 15 mg/5 mL; sustained-action Liq 30 mg/5 mL SE: GI disturbances Interactions: ↑ Effects W/ amiodarone, fluoxetine, quinidine, terbinafine; ↑ risk of serotonin syndrome W/ sibutramine, MAOIs; ↑ CNS depression W/ antihistamines, antidepressants, sedative, opioids, EtOH NIPE: ↑ Fluids, humidity to environment, stop MAOIs for 2 wk before administering drug; Found in combo OTC products w/ guaifenesin; deaths reported in <2 y; abuse potential; efficacy in children debated Diazepam (Valium, Diastat) [C-IV] [Anxiolytic, Skeletal Muscle Relaxant, Anticonvulsant, Sedative/Hypnotic/Benzodiazepine] Uses: *Anxiety, EtOH withdrawal, muscle spasm, status epilepticus, panic disorders, amnesia, preop sedation* Action: Benzodiazepine Dose: Adults. Status epilepticus: 5–10 mg q10–20min to 30 mg max in 8-h period. Anxiety, muscle spasm: 2–10 mg PO bid-qid or IM/IV q3–4h PRN. Preop: 5–10 mg PO or IM 20–30 min or IV just prior to procedure. EtOH withdrawal: Initial 2–5 mg IV, then 5–10 mg q5–10min, 100 mg in 1 h max. May require up to 1000 mg/24 h for severe withdrawal; titrate to agitation; avoid excessive sedation; may lead to aspiration or resp arrest. Peds. Status epilepticus: <5 y: 0.05–0.3 mg/kg/dose IV q15–30min up to a max of 5mg. >5 y: to max of 10 mg. Sedation, muscle relaxation: 0.04–0.3 mg/kg/dose q2–4h IM or IV to max of 0.6 mg/kg in 8 h, or 0.12–0.8 mg/kg/24 h PO ÷ tid-qid; ↓ w/ hepatic impair Caution: [D, ?/–] Contra: Coma, CNS depression, resp depression, NAG, severe uncontrolled pain, PRG Disp: Tabs 2, 5, 10 mg; soln 1, 5mg/mL; inj 5 mg/mL; rectal gel 2.5, 5, 10, 20 mg/mL SE: Sedation, amnesia, bradycardia, ↓ BP, rash, ↓ resp rate Notes: 5 mg/min IV max in adults or 1–2 mg/min in peds (resp arrest possible) Inter- actions: ↑ Effects W/ antihistamines, azole antifungals, BBs, CNS depressants, cimetidine, ciprofloxin, disulfiram, INH, OCP, omeprazole, phenytoin, valproic acid, verapamil, EtOH, kava kava, valerian; ↑ effects OF digoxin, diuretics; ↓ effects W/ barbiturates, carbamazepine, theophylline, ranitidine, tobacco; ↓ effects OF haloperidol, levodopa Labs: Monitor LFTs, BUN, Cr, CBC w/ long-term drug use NIPE: Risk ↑ Sz activity; IM absorption erratic; avoid abrupt D/C 100 Diazoxide

Diazoxide (Proglycem) [Antihypertensive/Peripheral Va- sodilator] Uses: *Hypoglycemia due to hyperinsulinism (Proglycem); hypertensive crisis (Hyperstat)* Action: ↓ Pancreatic insulin release; antihypertensive Dose: Repeat in 5–15 min until BP controlled; repeat every 4–24 h; monitor BP closely. Hypoglycemia: Adults & Peds. 3–8 mg/kg/24 h PO ÷ q8–12h. Neonates. 8–15 mg/kg/24 h ÷ in 3 equal doses; maint 8–10 mg/kg/24 h PO in 2–3 equal doses Caution: [C, ?] ↓ Effect w/ phenytoin; ↑ effect w/ diuretics, warfarin Contra: Al- lergy to thiazides or other sulfonamide-containing products; HTN associated w/ aortic coarctation, AV shunt, or pheochromocytoma Disp: Caps 50 mg; PO susp 50 ↓ + mg/mL SE: Hyperglycemia, BP, dizziness, Na & H2O retention, N/V, weakness Interactions: ↑ Effects W/ carboplatin, cisplatin, diuretics, phenothiazines; ↑ effects OF anticoagulants; ↓ effects W/ sulfonylureas; ↓ effects OF phenytoin, sulfonylureas Labs: ↑ Serum uric acid, glucose, false—response to glucagon; ↓ neutrophil count, HMG, Hct, WBC NIPE: Daily weights, ↑ reversible body hair growth; can give false—insulin response to glucagons; Rx extrav w/ warm compress Dibucaine (Nupercainal) [Topical Anesthetic] Uses: *Hemor- rhoids & minor skin conditions* Action: Topical anesthetic Dose: Insert PR w/ applicator bid & after each bowel movement; apply sparingly to skin Caution: [C, ?] Contra: Component sensitivity Disp: 1% oint w/ rectal applicator; 0.5% cream SE: Local irritation, rash Interactions: None noted Diclofenac (Cataflam, Felctor, Voltaren) [Antiarthritic, Anti- inflammatory/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID Dose: 50–75 mg PO bid; w/ food or milk; 1 patch to painful area BID Caution: [B (D 3rd tri or near delivery), ?] CHF, HTN, renal/hepatic dysfunction, & h/o PUD Contra: NSAID/ASA allergy; porphyria; perioperative pain following CABG Disp: Tabs 50 mg; tabs DR 25, 50, 75, 100 mg; XR tabs 100 mg; Flector Patch 10 × 14 cm, opht soln 0.1% SE: Abd cramps, heartburn, GI ulceration, rash, interstitial nephritis; patch: pruritus, dermatitis, burning, N, HA Interactions: ↑ Risk of bleeding W/ feverfew, garlic, ginger, ginkgo biloba; ↑ effects OF digoxin, MTX, cyclosporine, Li, insulin, sulfonylureas, K-sparing diuretics, warfarin; ↓ effects W/ ASA; ↓ effects OF thiazide diuretics, furosemide, BBs Labs: ↑ LFTs, serum glucose & cortisol, ↓ serum uric acid; monitor LFTs, CBC, BUN, Cr NIPE: Risk of photosensitivity—use sunscreen; take w/ food; N crush tabs; do not apply patch to damaged skin or while bathing; watch for GI bleed Dicloxacillin (Dynapen, Dycill) [Antibiotic/Penicillin] Uses: *Rx of pneumonia, skin, & soft tissue Infxns, & osteomyelitis caused by penicillinase-producing staphylococci* Action: Bactericidal; ↓ cell wall synth. Spectrum: S. aureus & Streptococcus Dose: Adults. 250–500 mg qid Peds <40 kg. 12.5–100 mg/kg/d ÷ qid; take on empty stomach Caution: [B, ?] Contra: Component or PCN sensitivity Disp: Caps 125, 250, 500 mg; soln 62.5 mg/5 mL SE: N/D, abd pain In- teractions: ↑ Effects W/ disulfiram, probenecid; ↑ effects OF MRX, ↓ effects W/ Diflunisal 101 macrolides, tetracyclines, food; ↓ effects OF OCPs, warfarin Labs: False ↑ urine glucose; ↑ eosinophils; ↓ HMG, Hct, plts, WBC NIPE: Take w/ water; monitor PTT if pt on warfarin Dicyclomine (Bentyl) [Antimuscarinic, GI Antispasmodic/ Anticholinergic] Uses: *Functional IBS* Action: Smooth-muscle relaxant Dose: Adults. 20 mg PO qid; ↑ to 160 mg/d max or 20 mg IM q6h, 80mg/d ÷ QID then ↑ to 160 mg/d, max 2 wk Peds. Infants >6 mo: 5mg/dose tid–qid. Children: 10 mg/dose tid–qid Caution: [B, –] Contra: Infants <6 mo, NAG, MyG, severe UC, BOO Disp: Caps 10, 20 mg; tabs 20 mg; syrup 10 mg/5 mL; inj 10 mg/mL SE: Anticholinergic SEs may limit dose Interactions: ↑ Anticholinergic effects W/ anticholinergics, antihistamines, amantadine, MAOIs, TCAs, phenothiazides; ↑ effects OF atenolol, digoxin; ↓ effects W/ antacids; ↓ effects OF haloperidol, ketoconazole, levodopa, phenothiazines NIPE: Do not administer IV; N EtOH, CNS depressant; adequate hydration; take 30–60 min before meal Didanosine [ddI] (Videx) [Antiretroviral, NRTI] WARNING: Allergy manifested as fever, rash, fatigue, GI/resp Sxs reported; D/C drug immediately & do not rechallenge; lactic acidosis & hepatomegaly/steatosis reported Uses: *HIV Infxn in zidovudine-intolerant pts* Action: NRTI Dose: Adults. >60 kg: 400 mg/d PO or 200 mg PO bid. <60 kg: 250 mg/d PO or 125 mg PO bid; adults should take 2 tabs/administration. Peds. 2 wk to 8 mo age 100 mg/m2, >8 mo 120 mg/m2 PO BID; ↓ in renal impair Caution: [B, –] CDC recommends HIV- infected mothers not to breast-feed Contra: Component sensitivity Disp: Chew tabs 25, 50, 100, 150, 200 mg; powder packets 100, 167, 250, 375 mg; powder for soln 2, 4 g SE: Pancreatitis, peripheral neuropathy, D, HA Interactions: ↑ Effects W/ allopurinol, ganciclovir; ↓ effects W/ methadone, food; ↑ risk of pancreatitis W/ thiazide diuretics, IV pentamidine, EtOH; ↓ effects OF azole antifungals, dapsone, delavirdine, ganciclovir, indinavir, quinoline, ranitidine, tetracycline Labs: ↑ LFTs, uric acid, amylase, lipase, triglycerides NIPE: May cause hyperglycemia; do not take w/ meals; thoroughly chew tablets, do not mix w/ fruit juice or acidic beverages; reconstitute powder w/ H2O Diflunisal (Dolobid) [Analgesic, Antipyretic, Anti-inflammatory/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Mild–moderate pain; osteoarthritis* Action: NSAID Dose: Pain: 500 mg PO bid. Osteoarthritis: 500–1500 mg PO in 2–3 ÷ doses; ↓ in renal impair, take w/ food/milk Caution: [C (D 3rd tri or near delivery), ?] CHF, HTN, renal/hepatic dysfunction, & h/o PUD Contra: Allergy to NSAIDs or ASA, active GI bleed Disp: Tabs 250, 500 mg SE: May ↑ bleeding time; HA, abd cramps, heartburn, GI ulceration, rash, interstitial nephritis, fluid retention Interactions: ↑ Effects W/ probenecid; ↑ effects OF acetaminophen, anticoagulants, digoxin, HCTZ, indomethacin, Li, MTX, phenytoin, sulfonamides, sulfonylureas; ↓ effects W/ antacids, ASA; ↓ effects OF furosemide Labs: ↑ Salicylate levels NIPE: Take w/ food, N chew or crush tabs 102 Digoxin

Digoxin (Lanoxin, Lanoxicaps, Digitek) [Antiarrhythmic/ Cardiac Glycoside] Uses: *CHF, AF & flutter, & PAT* Action: Positive inotrope; ↑ AV node refractory period Dose: Adults. PO digitalization: 0.5–0.75 mg PO, then 0.25 mg PO q6–8h to total 1–1.5 mg. IV or IM digitalization: 0.25–0.5 mg IM or IV, then 0.25 mg q4–6h to total 0.125–0.5 mg/d PO, IM, or IV (average daily dose 0.125–0.25 mg). Peds. Preterm infants: Digitalization: 30 μg/kg PO or 25 μg/kg IV; give 1/2 of dose initial, then 1/4 of dose at 8–12-h intervals for 2 doses. Maint: 5–7.5 μg/kg/24 h PO or 4–6 μg/ kg/24 h IV ÷ q12h. Term infants: Digitalization: 25–35 μg/kg PO or 20–30 μg/kg IV; give 1/2 the initial dose, then 1/3 of dose at 8–12 h. Maint: 6–10 μg/kg/24 h PO or 5–8 μg/kg/24 h ÷ q12h. 1 mo–2 y: Digitalization: 35–60 μg/kg PO or 30–50 μg/kg IV; give 1/2 the initial dose, then 1/3 dose at 8–12-h intervals for 2 doses. Maint: 10–15 μg/kg/24 h PO or 7.5–15 μg/kg/24 h IV ÷ q12h. 2–10 y: Digitalization: 30–40 μg/kg PO or 25 μg/kg IV; give 1/2 initial dose, then 1/3 of the dose at 8–12-h intervals for 2 doses. Maint: 8–10 μg/kg/24 h PO or 6–8 μg/kg/24 h IV ÷ q12h. 7–10 y: Same as for adults; ↓ in renal impair Caution: [C, +] Contra: AV block; idiopathic hypertrophic subaortic stenosis; constrictive pericarditis Disp: Caps 0.05, 0.1, 0.2 mg; tabs 0.125, 0.25, 0.5 mg; elixir 0.05 mg/mL; inj 0.1, 0.25 mg/mL SE: Can cause heart block; ↓ K+ potentiates tox; N/V, HA, fatigue, visual disturbances (yellow-green halos around lights), cardiac arrhythmias Notes: Levels: Trough:Just before next dose. Thera- peutic: 0.8–2.0 ng/mL. Toxic: >2 ng/mL. 1/2 life: 36 h Interactions: ↑ Effects W/ alprazolam, amiodarone, azole antifungals, BBs, carvedilol, cyclosporine, corticosteroids, diltiazem, diuretics, erythromycin, NSAIDs, quinidine, spironolactone, tetracyclines, verapamil, goldenseal, hawthorn, licorice, quinine, Siberian ginseng; ↓ effects W/ charcoal, cholestyramine, cisapride, neomycin, rifampin, sucralfate, thyroid hormones, psyllium, St. John’s wort Labs: Monitor serum electrolytes NIPE: Different bioavailability in various brands; IM inj painful, has erratic absorption & should not be used Digoxin Immune Fab (Digibind, DigiFab) [Cardiac Glycoside Antidote/Antibody Fragment] Uses: *Life-threatening digoxin intox* Action: Antigen-binding fragments bind & inactivate digoxin Dose: Adults & Peds. Based on serum level & pt’s wt; see charts provided w/ drug Caution: [C, ?] Contra: Sheep product allergy Disp: Inj 38 mg/vial SE: Worsening of cardiac output or CHF, ↓ K+, facial swelling, & redness Notes: Each vial binds ≈0.6 mg of digoxin Interactions: ↓ Effects OF cardiac glycosides; ↓ K+ level NIPE: Will take up to 1 wk for accurate serum digoxin levels after use of Digibind; renal failure may require redosing in several days Diltiazem (Cardizem, Cardizem CD, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Taztia XT, Tiamate, Tiazac ) [Antianginal/ CCB] Uses: *Angina, prevention of reinfarction, HTN, AF or flutter, & PAT* Action: CCB Dose: PO: Initial, 30 mg PO qid; ↑ to 180–360 mg/d in 3–4 ÷ doses PRN. SR: 60–120 mg PO bid; ↑ to 360 mg/d max. CD or XR: 120–360 mg/d (max Dinoprostone 103

480 mg/d). IV: 0.25 mg/kg IV bolus over 2 min; may repeat in 15 min at 0.35 mg/kg; begin inf of 5–15 mg/h. Acute rate control: 15–20 mg (0.25 mg/kg) IV over 2 min, Repeat in 15 min at 20–25 mg (0.35 mg/kg) over 2 min (ECC 2005) Caution: [C, +] ↑ Effect W/ amiodarone, cimetidine, fentanyl, lithium, cyclosporine, digoxin, β-blockers, theophylline Contra: SSS, AV block, ↓ BP, AMI, pulm congestion Disp: Cardizem CD: Caps 120, 180, 240, 300, 360 mg; Cardizem SR: caps 60, 90, 120 mg; Cardizem: Tabs 30, 60, 90, 120 mg; Cartia XT: Caps 120, 180, 240, 300 mg; Dilacor XR: Caps 180, 240 mg; Diltia XT: Caps 120, 180, 240 mg; Tiazac: Caps 120, 180, 240, 300, 360, 420 mg; Tiamate (XR): Tabs 120, 180, 240 mg; inj 5 mg/mL; Taztia XT: 120, 180, 240, 300, 360 mg SE: Gingival hyperplasia, bradycardia, AV block, ECG abnormalities, peripheral edema, dizziness, HA Notes: Cardizem CD, Dilacor XR, & Tiazac not interchangeable Interactions: ↑ α Effects W/ -blockers, azole antifungals, BBs, erythromycin, H2-receptor antagonists, nitroprusside, quinidine, EtOH, grapefruit juice; ↑ effects OF carbamazepine, cyclosporine, digitalis glycosides, quinidine, phenytoin, prazosin, theophylline, TCAs; ↓ effects W/ NSAIDs, phenobarbital, rifampin Labs: ↑ LFTs NIPE: N Chew or crush SR or ER preps; risk of photosensitivity—use sunscreen Dimenhydrinate (Dramamine, others) [Antiemetic/Antiver- tigo/Anticholinergic] Uses: *Prevention & Rx of N/V, dizziness, or vertigo of motion sickness* Action: Antiemetic Dose: Adults. 50–100 mg PO q4–6h, max 400 mg/d; 50 mg IM/IV PRN. Peds. 2–6 y: 12.5–25 mg q6–8h max 75 mg/d. 6–12 y: 25–50 mg q6–8h max 150 mg/d Caution: [B, ?] Contra: Component sensitivity Disp: Tabs 50 mg; chew tabs 50 mg; Liq 12.5 mg/4 mL, 12.5 mg/5 mL, 15.62 mg/5 mL SE: Anticholinergic side effects Interactions: ↑ Effects W/ CNS depressants, antihistamines, opioids, quinidine, TCAs, EtOH; prolonged anticholinergic effects W/ MAOIs Labs: False ↓ allergy skin tests NIPE: N Drug 72 h prior to allergy skin testing, take before motion sickness occurs Dimethyl Sulfoxide [DMSO] (Rimso 50) [GU Agent] Uses: *Interstitial cystitis* Action: Unknown Dose: Intravesical, 50 mL, retain for 15 min; repeat q2wk until relief Caution: [C, ?] Contra: Component sensitivity Disp: 50% & 100% soln SE: Cystitis, eosinophilia, GI, & taste disturbance Interactions: ↓ Effects OF sulindac Labs: Monitor CBC, LFTs, BUN, Cr levels NIPE: ↑ Taste & smell of garlic Dinoprostone (Cervidil Vaginal Insert, Prepidil Vaginal Gel, Prostin E2) [Prostaglandin/Abortifacient] WARNING: Should only be used by trained personnel in an appropriate hospital setting Uses: *Induce labor; terminate PRG (12–20 wk); evacuate uterus in missed abortion or fetal death* Action: Prostaglandin, changes consistency, dilatation, & effacement of the cervix; induces uterine contraction Dose: Gel: 0.5 mg; if no cervical/uterine response, repeat 0.5 mg q6h (max 24-h dose 1.5 mg). Vaginal insert: 1 insert (10 mg = 0.3 mg dinoprostone/h over 12 h); remove w/ onset of labor or 12 h after insertion. Vaginal supp: 20 mg repeated every 3–5 h; adjust PRN supp: 1 high in vagina, 104 Diphenhydramine repeat at 3–5-h intervals until abortion (240 mg max) Caution: [X, ?] Contra: Ruptured membranes, allergy to prostaglandins, placenta previa or AUB, when oxytocic drugs contraindicated or if prolonged uterine contractions are inappropriate (h/o C-section, cephalopelvic disproportion, etc) Disp: Endocervical gel: 0.5 mg in 3-g syringes (w/ 10- & 20-mm shielded catheter) Vaginal gel: 0.5 mg/3 g Vaginal supp: 20 mg Vaginal insert, CR: 10 mg SE: N/V/D, dizziness, flushing, HA, fever, abnormal uterine contractions Interactions: ↑ Effects of oxytocics, ↓ effects W/ large amts ETOH NIPE: Pt supine after insertion of supp or gel up to 1/2 h Diphenhydramine (Benadryl) [OTC] [Antihistamine/Antitus- sive/Antiemetic] Uses: *Rx & prevent allergic Rxns, motion sickness, potentiate narcotics, sedation, cough suppression, & Rx of extrapyramidal Rxns* Action: Antihistamine, antiemetic Dose: Adults. 25–50 mg PO, IV, or IM bid–tid. Peds. > 2 y: 5 mg/kg/24 h PO or IM ÷ q6h (max 300 mg/d); ↑ dosing interval w/ moderate–severe renal insuff Caution: [B, –] Contra: acute asthma Disp: Tabs, caps 25, 50 mg; chew tabs 12.5 mg; elixir 12.5 mg/5 mL; syrup 12.5 mg/5 mL; Liq 6.25 mg/5 mL, 12.5 mg/5 mL; inj 50 mg/mL, cream 2% SE: Anticholinergic (xerostomia, urinary retention, sedation) Interactions: ↑ Effects W/ CNS depressants, antihistamines, opioids, MAOIs, TCAs, EtOH Labs: ↓ Response to allergy skin testing; ↓ HMG, Hct, plts NIPE: ↑ Risk of photosensitivity—use sunscreen; may cause drowsiness Diphenoxylate + Atropine (Lomotil, Lonox) [C-V] [Opioid Antidiarrheal] Uses: *D* Action: Constipating meperidine congener, ↓ GI motility Dose: Adults. Initial, 5 mg PO tid–qid until controlled, then 2.5–5 mg PO bid; 20 mg/d max Peds >2 y: 0.3–0.4 mg/kg/24 h (of diphenoxylate) bid–qid, 10 mg/d max Caution: [C, +] Contra: Obstructive jaundice, D due to bacterial Infxn; children <2 y Disp: Tabs 2.5 mg diphenoxylate/0.025 mg atropine; Liq 2.5 mg diphenoxylate/0.025 mg atropine/5 mL SE: Drowsiness, dizziness, xerostomia, blurred vision, urinary retention, constipation Interactions: ↑ Effects W/ CNS depressants, opioids, EtOH, ↑ risk HTN crisis W/ MAOIs NIPE: ↓ Effective- ness w/ diarrhea caused by antibiotics Diphtheria, Tetanus Toxoids, & Acellular pertussis adsorbed, Hepatitis B (Recombinant), & Inactivated Poliovirus Vaccine [IPV] combined (Pediarix) [Vaccine, Inactivated] Uses: *Vaccine against diphtheria, tetanus, pertussis, HBV, polio (types 1, 2, 3) as a 3-dose primary series in infants & children <7, born to HBsAg–mothers* Actions: Active immunization Dose: Infants: Three 0.5-mL doses IM, at 6–8-wk intervals, start at 2 mo; child given 1 dose of Hep B vaccine, same; previously vaccinated w/ one or more doses IPV, use to complete series Caution: [C, N/A] Contra: HbsAg+ mother, adults, children >7 y, immunosuppressed, allergy to yeast, neomycin, polymyxin B, or any component, encephalopathy, or progressive neurologic disorders; caution in bleeding disorders. Disp: Single-dose vials 0.5 mL SE: Drowsiness, restlessness, fever, fussiness, ↓ appetite, nodule redness, inj site Disopyramide 105 pain/swelling Interactions: ↓ Effects W/ immunosuppressants, corticosteroids NIPE: If IM use only preservative-free injection Dipivefrin (Propine) [Alpha Adrenergic Agonist/Glaucoma Agent] Uses: *Open-angle glaucoma* Action: α-Adrenergic agonist Dose: 1 gtt in eye q12h Caution: [B, ?] Contra: NAG Disp: 0.1% soln SE: HA, local irritation, blurred vision, photophobia, HTN Interactions: ↑ Effects W/ BBs, ophthalmic anhydrase inhibitors, osmotic drugs, sympathomimetics, ↑ risk of cardiac arrhythmias W/ digoxin, TCAs NIPE: Discard discolored solutions Dipyridamole (Persantine) [Coronary Vasodilator/Platelet Aggregation Inhibitor] Uses: *Prevent postop thromboembolic disorders, often in combo w/ ASA or warfarin (eg, CABG, vascular graft); w/ warfarin after artificial heart valve; chronic angina; w/ ASA to prevent coronary artery thrombosis; dipyridamole IV used in place of exercise stress test for CAD* Action: Antiplt activity; coronary vasodilator Dose: Adults. 75–100 mg PO tid–qid; stress test 0.14 mg/kg/min (max 60 mg over 4 min). Peds >12 y. 3–6 mg/kg/d ÷ tid (safety/efficacy not established) Caution: [B, ?/–] w/ other drugs that affect coagulation Contra: Component sensitivity Disp: Tabs 25, 50, 75 mg; inj 5 mg/mL SE: HA, ↓ BP, N, abd distress, flushing rash, dizziness, dyspnea Interac- tions: ↑ Effects W/ anticoagulants, heparin, evening primrose oil, feverfew, garlic, ginger, ginkgo biloba, ginseng, grapeseed extract; ↑ effects OF adenosine; ↑ bradycardia W/ BBs; ↓ effects W/ aminophylline NIPE: IV use can worsen angina; N EtOH or tobacco because of vasoconstriction effects; + effects may take several mo Dipyridamole & Aspirin (Aggrenox) [Platelet Aggregation Inhibitor] Uses: *↓ Reinfarction after MI; prevent occlusion after CABG; ↓ risk of stroke* Action: ↓ Plt aggregation (both agents) Dose: 1 cap PO bid Caution: [C, ?] Contra: Ulcers, bleeding diathesis Disp: Dipyridamole (XR) 200 mg/ASA 25 mg SE: ASA component: allergic Rxns, skin Rxns, ulcers/GI bleed, bronchospasm; dipyridamole component: dizziness, HA, rash Interactions: ↑ Risk of GI bleed W/ EtOH, NSAIDs; ↑ effects OF acetazolamide, adenosine, anticoagulants, methotrexate, oral hypoglycemics; ↓ effects OF ACEIs, BB, cholinesterase inhibitors, diuretics NIPE: Swallow capsule whole Dirithromycin (Dynabac) [Antibiotic, Macrolide] Uses: *Bron- chitis, community-acquired pneumonia, & skin & skin structure Infxns* Action: Macrolide antibiotic. Spectrum: M. catarrhalis, S. pneumoniae, Legionella, H. influenzae, S. pyogenes, S. aureus Dose: 500 mg/d PO; w/ food; swallow whole Caution: [C, M] Contra: w/ pimozide Disp: Tabs 250 mg SE: Abd discomfort, HA, rash, ↑ K+ NIPE: Eval for macrolide sensitivity; take with food and swallow tablet whole Disopyramide (Norpace, Norpace CR, NAPamide, Rhyth- modan) [Antarrhythmic/Pyridine Derivative] WARNING: Ex- cessive mortality or nonfatal cardiac arrest rate with use in asymptomatic non-life-threatening ventricular arrhythmias with MI 6 d to 2 y prior. Restrict use 106 Dobutamine to life-threatening arrhythmias only Uses: *Suppression & prevention of VT* Ac- tion: Class 1A antiarrhythmic; stabilizes membranes, depresses action potential Dose: Adults. 400–600 mg/d ÷ q6h or q12h for CR, max 1600 mg/d. Peds. <1 y: 10–30 mg/kg/24 h PO (÷ qid). 1–4 y: 10–20 mg/kg/24 h PO (÷ qid). 4–12 y: 10–15 mg/kg/24 h PO (÷ qid). 12–18 y: 6–15 mg/kg/24 h PO (÷ qid); ↓ in renal/hepatic impair Caution: [C, +] Contra: AV block, cardiogenic shock,↓ BP, CHF Disp: Caps 100, 150 mg; CR caps 100, 150 mg SE: Anticholinergic SEs; negative inotrope, may induce CHF Notes: Levels: Trough: Just before next dose: Therapeutic: 2–5 μg/mL; Toxic: >5 μg/mL; 1/2 life: 4–10 h Interactions: ↑ Effects W/ cimetidine, clarithromycin, erythromycin, quinidine; ↑ effects OF digoxin, hypoglycemics, insulin, warfarin; ↑ risk of arrhythmias W/ pimozide; ↓ effects W/ barbiturates, phenytoin, phenobarbital, rifampin Labs: ↑ LFTs, lipids, BUN, Cr; ↓ serum glucose, HMG, Hct NIPE: Risk of photosensitivity—use sunscreen; daily wt Dobutamine (Dobutrex) [Inotropic/Adrenergic, Beta-1- Agonist] Uses: *Short-term in cardiac decompensation secondary to depressed contractility* Action: Positive inotrope Dose: Adults & Peds. Cont IV inf of 2.5–15 μg/kg/min; rarely, 40 μg/kg/min required; titrate; 2–20 μg/kg/min; titrate to HR not >10% of baseline (ECC 2005) Caution: [C, ?] Contra: Sensitivity to sulfites, IHSS Disp: Inj 250 mg/20 mL, 12.5/mL SE: Chest pain, HTN, dyspnea Interactions: ↑ Effects W/ furazolidone, methyldopa, MAOIs, TCAs; ↓ effects W/ ↓ ↓ BBs, NaHCO3; effects OF guanethidine Labs: K NIPE: Eval for adequate hydration; monitor I&O; monitor PWP & cardiac output if possible; monitor ECG for ↑ HR or ectopic activity, monitor BP Docetaxel (Taxotere) [Antineoplastic/Antimitotic Agent] WARNING: Do not administer if neutrophil count <1500 cell/mm3; severe Rxns possible in hepatic dysfxn Uses: *Breast (anthracycline-resistant), ovarian, lung, & prostate CA* Action: Antimitotic agent; promotes microtubular aggregation; semisynthetic taxoid Dose: 100 mg/m2 over 1 h IV q3wk (per protocols); dexamethasone 8 mg bid prior & continue for 3–4 d; ↓ dose w/ ↑ bilirubin levels Caution: [D, –] Contra: Sensitivity to meds w/ polysorbate 80, component sensitivity Disp: Inj 20 mg/0.5 mL, 80 mg/2 mL SE: ↓ BM, neuropathy, N/V, alopecia, fluid retention synd; cumulative doses of 300–400 mg/m2 w/o steroid prep & posttreatment & 600–800 mg/m2 w/ steroid prep; allergy possible (rare w/ steroid prep) Interac- tions: ↑ Effects W/ cyclosporine, ketoconazole, erythromycin, terfenidine Labs: ↑ AST, ALT, alkaline phosphatase, bilirubin; ↓ plts, WBCs; monitor CBC during therapy NIPE: ↑ Fluids to 2–3 L/d, ↑ risk of hair loss, ↑ susceptibility to Infxn; urine may become reddish-brown Docusate Calcium (Surfak)/Docusate Potassium (Dialose)/ Docusate Sodium (DOSS, Colace) [Emollient Laxative/Fecal Softener] Uses: *Constipation; adjunct to painful anorectal conditions (hemorrhoids)* Action: Stool softener Dose: Adults. 50–500 mg PO ÷ daily qid. Peds. Infants–3 y: 10–40 mg/24 h ÷ daily qid. 3–6 y: 20–60 mg/24 h ÷ daily qid. 6–12 y: Dopamine 107

40–120 mg/24 h ÷ daily qid Caution: [C, ?] Contra: Use w/ mineral oil; intestinal obst, acute abd pain, N/V Disp: Ca: Caps 50, 240 mg. K: Caps 100, 240 mg. Na: Caps 50, 100 mg; syrup 50, 60 mg/15 mL; Liq 150 mg/15 mL; soln 50 mg/mL SE: Rare abd cramping, D Interactions: ↑ Absorption of mineral oil NIPE: Take w/ full glass of H2O; no laxative action; do not use >1 wk; short-term use Dofetilide (Tikosyn) [Antiarrhythmic] WARNING: To minimize the risk of induced arrhythmia, hospitalize for minimum of 3 d to provide calcula- tions of CrCl, continuous ECG monitoring, & cardiac resuscitation Uses: *Main- tain normal sinus rhythm in AF/A flutter after conversion* Action: Type III antiarrhythmic, prolongs action potential Dose: Based on CrCl & QTc; CrCl >60 mL/min 500 μg PO q12h, check QTc 2–3 h after, if QTc >15% over baseline or >500 msec, ↓ to 250 μg q12h, after each dose; if CrCl <60 mL/sec, see insert; D/C if QTc > 500 msec after dosing adjustments Caution: [C, –] Contra: Baseline QTc >440 ms, CrCl <20 mL/min; w/ verapamil, cimetidine, trimethoprim, ketoconazole, quinolones, ACE inhibitors/HCTZ combo Disp: Caps 125, 250, 500 μg SE: Vent arrhythmias, QT ↑, torsades de pointes, rash, HA, CP, dizziness Notes: Restricted to participating prescribers Interactions: ↑ Effects W/ amiloride, amiodarone, azole antifungals, cimetidine, diltiazem, macrolides, metformin, megestrol, nefazodone, norfloxacin, SSRIs, TCAs, triamterene, trimethoprim, verapamil, zafirlukast, quinine, grapefruit juice Labs: Monitor LFTs, BUN, Cr NIPE: Take w/o regard to food; Avoid w/ other drugs that ↑ QT interval; hold class I/III antiarrhythmics for 3 half-lives prior to dosing; amiodarone level should be <0.3 mg/L before use, do not initiate if HR <60 BPM Dolasetron (Anzemet) [Antiemetic/Selective Serotonin 5-HT3 Receptor Antagonist] Uses: *Prevent chemo-associated N/V* Action: 5-HT3 receptor antagonist Dose: Adults & Peds. IV: 1.8 mg/kg IV as single dose 30 min prior to chemo Adults. PO: 100 mg PO as a single dose 1 h prior to chemo Peds. PO: 1.8 mg/kg PO to max 100 mg as single dose Caution: [B, ?] Contra: Component sensitivity Disp: Tabs 50, 100 mg; inj 20 mg/mL SE: ↑ QT interval, D, HTN, HA, abd pain, urinary retention Interactions: ↑ Effects W/ cimetidine; ↑ risk of arrhythmias W/ diuretics; ↓ effects W/ rifampin Labs: Transient ↑ LFTs NIPE: Monitor ECG for prolonged QT interval; frequently causes HA Dopamine (Intropin) [Vasopressor/Adrenergic] Uses: *Short- term use in cardiac decompensation secondary to ↓ contractility; ↑ organ perfusion (at low dose)* Action: Positive inotropic agent w/ dose response: 1–10 μg/kg/min β-effects (↑ CO & renal perfusion); 10–20 μg/kg/min β-effects (peripheral vasoconstriction, pressor); >20 μg/kg/min peripheral & renal vasoconstriction Dose: Adults & Peds. 5 μg/kg/min by cont inf, ↑ by 5 μg/kg/min to 50 μg/kg/min max to effect (ECC 2005) Caution: [C, ?] Contra: Pheochromocytoma, VF, sulfite sensitivity Disp: Inj 40, 80, 160 mg/mL, premixed 0.8 , 1.6 , 3.2 mg/mL SE: Tachycar- dia, vasoconstriction, ↓ BP, HA, N/V, dyspnea Notes: >10 μg/kg/min ↓ renal perfusion Interactions: ↑ Effects W/ α-blockers, diuretics, ergot alkaloids, 108 Dornase Alfa

MAOIs, BBs, anesthetics, phenytoin; ↓ effects W/ guanethidine Labs:↑ Glucose, urea levels NIPE: Maintain adequate hydration; monitor urinary output & ECG for ↑ HR, BP, ectopy; monitor PCWP & cardiac output if possible; phentolamine used for extrav Dornase Alfa (Pulmozyme, DNase) [Respiratory Inhalant/ Enzyme] Uses: *↓ Frequency of resp Infxns in CF* Action: Enzyme cleaves extracellular DNA, ↓ mucous viscosity Dose: Adult: Inhal 2.5 mg/d, bid dosing w/ FVC >85% w/ recommended nebulizer Peds > 5 y: Inhal 2.5 mg/d, bid if FVC >85% Caution: [B, ?] Contra: Chinese hamster product allergy Disp: Soln for inhal 1 mg/mL SE: Pharyngitis, voice alteration, CP, rash NIPE: Teach pt to use nebulizer Dorzolamide (Trusopt) [Carbonic Anhydrase Inhibitor, Sul- fonamide/Glaucoma Agent] Uses: *Glaucoma* Action: Carbonic anhydrase inhibitor Dose: 1 gtt in eye(s) tid Caution: [C, ?] Contra: Component sensitivity Disp: 2% soln SE: Irritation, bitter taste, punctate keratitis, ocular allergic Rxn Interactions: ↑ Effects W/ oral carbonic anhydrase inhibitors, salicylates NIPE: N Wear soft contact lenses Dorzolamide & Timolol (Cosopt) [Carbonic Anhydrase In- hibitor/Beta-Adrenergic Blocker] Uses: *Glaucoma* Action: Car- bonic anhydrase inhibitor w/ β-adrenergic blocker Dose: 1 gtt in eye(s) bid Caution: [C, ?] CrCl <30 Contra: Component sensitivity, asthma, severe COPD, sinus bradycardia Disp: Soln dorzolamide 2% & timolol 0.5% SE: Irritation, bitter taste, superficial keratitis, ocular allergic Rxn NIPE: N Wear soft contact lenses Doxazosin (Cardura, Cardura XL) [Antihypertensive/ α Alpha-Blocker] Uses: *HTN & symptomatic BPH* Action: 1-Adrenergic blocker; relaxes bladder neck smooth muscle Dose: HTN: Initial 1 mg/d PO; may be ↑ to 16 mg/d PO. BPH: Initial 1 mg/d PO, may ↑ to 8 mg/d; XR 2–8mg qAM Caution: [B, ?] Contra: Component sensitivity Disp: Tabs 1, 2, 4, 8 mg; XR 4, 8 mg SE: Dizziness, HA, drowsiness, sexual dysfunction, doses >4 mg ↑ postural ↓ BP risk Interactions: ↑ Effects W/ nitrates, antihypertensives, EtOH; ↓ effects W/ NSAIDs, butcher’s broom; ↓ effects OF clonidine NIPE: May be taken w/ food; 1st dose hs; syncope may occur w/in 90 min of initial dose Doxepin (Adapin) [Antidepressant/TCA] WARNING: Closely monitor for worsening depression or emergence of suicidality Uses: *Depression, anxiety, chronic pain* Action: TCA; ↑ synaptic CNS serotonin or norepinephrine Dose: 25–150 mg/d PO, usually hs but can ÷ doses; up to 300 mg/d for depression ↓ in hepatic impair Caution: [C, ?/–] Contra: NAG, urinary retention, MAOI use w/in 14 d, in recovery phase of MI Disp: Caps 10, 25, 50, 75, 100, 150 mg; PO conc 10 mg/mL SE: Anticholinergic SEs, ↓ BP, tachycardia, drowsiness, photosens Interactions: ↑ Effects W/ fluoxetine, MAOIs, albuterol, CNS depressants, anticholinergics, propoxyphene, quinidine, EtOH, grapefruit juice; ↑ effects OF carbamazepine, anticoagulants, amphetamines, thyroid drugs, sympathomimetics; Doxycycline 109

↓ effects W/ ascorbic acid, cholestyramine, tobacco; ↓ effects OF bretylium, guanethidine, levodopa Labs: ↑ Serum bilirubin, alkaline phosphatase, glucose NIPE: Risk of photosensitivity—use sunscreen, urine may turn blue-green, may take 4–6 wk for full effect Doxepin, Topical (Zonalon, Prudoxin) [Antipruritic] Uses: *Short-term Rx pruritus (atopic dermatitis or lichen simplex chronicus)* Action: Antipruritic; H1- & H2-receptor antagonism Dose: Apply thin coating qid, 8 d max Caution: [C, ?/–] Contra: Component sensitivity Disp: 5% cream SE: ↓ BP, tachycardia, drowsiness NIPE: Limit application area to avoid systemic tox; photosensitivity—use sunscreen Doxorubicin (Adriamycin, Rubex) [Antineoplastic/Anthra- cycline Antibiotic] Uses: *Acute leukemias; Hodgkin Dz & NHLs; soft tissue, osteo & Ewing sarcoma; Wilms tumor; neuroblastoma; bladder, breast, ovarian, gastric, thyroid, & lung CA* Action: Intercalates DNA; ↓ DNA topoisomerases I & II Dose: 60–75 mg/m2 q3wk; ↓ w/ hepatic impair; IV use only ↓ cardiotox w/ weekly (20 mg/m2/wk) or cont inf (60–90 mg/m2 over 96 h); (per protocols) Cau- tion: [D, ?] Contra: Severe CHF, cardiomyopathy, preexisting ↓ BM, previous Rx w/ total cumulative doses of doxorubicin, idarubicin, daunorubicin Disp: Inj 10, 20, 50, 75, 150, 200 mg SE: ↓ BM, venous streaking & phlebitis, N/V/D, mucositis, radiation recall phenomenon, cardiomyopathy rare(dose-related) Notes: Limit of 550 mg/m2 cumulative dose (400 mg/m2 w/ prior mediastinal irradiation); dexrazoxane may limit cardiac tox Interactions: ↑ Effects W/ streptozocin, verapamil, green tea; ↑ BM depression W/ antineoplastic drugs and radiation; ↓ effects W/ phenobarbital; ↓ effects OF digoxin, phenytoin, live virus vaccines Labs: ↑ Bilirubin, glucose, urine, & plasma uric acid levels; ↓ Ca, HMG, Hct, plts, WBCs NIPE: N PRG, use contraception at least 4 mo after drug Rx; red/orange urine; tissue damage w/ extrav Doxycycline (Adoxa, Periostat, Oracea, Vibramycin, Vibra- Tabs) [Antibiotic/Tetracycline] Uses: *Broad-spectrum antibiotic* acne vulgaris, uncomplicated GC, Chlamydia sp, PID, Lyme disease, skin Infxns, anthrax, malaria prophylaxis Action: Tetracycline; bacteriostatic; ↓ protein synth. Spectrum: Some gram(+) and (–), Rickettsia sp, Chlamydia sp, M. pneumoniae, B. Anthraxus Dose: Adults. 100 mg PO q12h on 1st d, then 100 mg PO daily bid or 100 mg IV q12h; acne daily dosing, Chlamydia 7d, Lyme disease 14–21 d, PID 14 d Peds >8 y: 5 mg/kg/24 h PO, to a max of 200 mg/d ÷ daily–bid Caution: [D, +] Hepatic impair Contra: Children <8 y, severe hepatic dysfunction Disp: Tabs 20, 50, 75, 100, 150 mg; caps 50, 100 mg; Oracea 40 mg caps (30 mg timed release, 10 mg delayed release); syrup 50 mg/5 mL; susp 25 mg/5 mL; inj 100, 200 mg/vial SE: D, GI disturbance, photosens Interactions: ↑ Effects OF digoxin, warfarin; ↓ effects W/ antacids, Fe, barbiturates, carbamazepine, phenytoins, food; ↓ effects OF penicillins Labs: ↑ LFTs, BUN, eosinophils; ↓ HMG, Hct, plts, neutrophils, WBC NIPE: ↑ Risk of super Infxn, N PRG, use barrier contraception; tetracycline of choice w/in renal impair; for inhalational anthrax use w/ 1–2 additional antibiotics, not for CNS anthrax 110 Dronabinol

Dronabinol (Marinol) [C-II] [Antiemetic, Appetite Stimulant/ Antivertigo] Uses: *N/V associated w/ CA chemo; appetite stimulation*Ac- tion: Antiemetic; ↓ V center in the medulla Dose: Adults & Peds. Antiemetic: 5–15 mg/m2/dose q4–6h PRN. Adults. Appetite stimulant: 2.5 mg PO before lunch & dinner; max 20 mg/d Caution: [C, ?] Contra: h/o schizophrenia, sesame oil hypersensitivity Disp: Caps 2.5, 5, 10 mg SE: Drowsiness, dizziness, anxiety, mood change, hallucinations, depersonalization, orthostatic ↓ BP, tachycardia Interac- tions: ↑ Effects W/ anticholinergics, CNS depressants, EtOH; ↓ effects OF theophylline NIPE: Principal psychoactive substance present in marijuana Droperidol (Inapsine) [General Anesthetic/Butyrophenone] Uses: *N/V; anesthetic premedication, AIDS-associated anorexia* Action: Tran- quilizer, sedation, antiemetic Dose: Adults. N: initial max 2.5 mg IV/IM, may repeat 1.25 mg based on response; Premed: 2.5–10 mg IV, 30–60 min preop. Peds. Premed: 0.1–0.15 mg/kg/dose Caution: [C, ?] Contra: Component sensitivity Disp: Inj 2.5 mg/mL SE: Drowsiness, ↓ BP, occasional tachycardia & extrapyramidal Rxns, ↑ QT interval, arrhythmias Interactions: ↑ Effects W/ CNS depressants, fentanyl, EtOH; ↑ hypotension W/ antihypertensives, nitrates NIPE: Give IVP slowly over 2–5 min Drospirenone/Estradiol (Angelia) [Estrogen & Progestin Supl] Uses: Women w/ uterus for moderate to severe vasomotor symp of menopause; symp of vulvar & vaginal atrophy d/t menopause Action: Estrogen & progestin supl; Dose: 1 tab PO OD Caution: [X, –] Contra: Genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, hepatic impair, adrenal insuff, renal insuff Disp: Tabs drospirenone 0.5mg/estradiol 1 mg SE: HA, breast pain, irreg vaginal bleeding/ spotting, abd cramps/bloating, N, V, hair loss, HTN, edema, yeast Infxn, fibroid enlargement Interactions: ↑ Risk of hyperkalemia W/ ACEIs, ARBs, aldosterone antagonists, heparin, NSAIDs, spirolactone, K+ sparing diuretics, K+ supl, Labs: ↑ ↓ ↑ ↑ Uptake OF T3, T4 sex hormone-binding globulin levels; lipids; Prothrombin & factors VII, VIII, IX, X, plt aggregability NIPE: Antialdosterone activity ↑ risk of hyperkalemia in high risk pts; in pts taking meds that ↑ K+ monitor serum K+ during 1st treatment cycle; no effected by food intake Drospirenone/Ethinyl Estradiol (YAZ) [Estrogen & Progestin Supl] WARNING: Cigarette smoking & use of estrogen-based OCPs have ↑ risk of serious cardiovascular SEs; risk ↑ w/ age (esp.>35 y) and smoking >15 cig/d Uses: OCPs; premenstrual dysphoric disorder Action: Suppresses ovulation by imitating the feedback inhibition of endogenous estrogen and progesterone on the pituitary and hypothalamus Dose: 1 tab PO OD × 28 d, repeat Caution: [X, –], has antimineralocorticoid activity w/ potential hyperkalemia in renal, adrenal, & hepatic insuff Contra: Pts w/ renal insuff, hepatic impair, adrenal insuff, DVT, PE, CVD, CAD, estrogen-dependent neoplasms, abnormal uterine bleeding, pregnancy, heavy smokers >35 y Disp: Drospirenone (3 mg)/ethinyl estradiol (20 μg), Duloxetine 111

28 d pack has 24 active tabs & 4 inert tabs SE: Hyperkalemia, HTN, N, V, HA, breakthrough bleeding, amenorrhea, mastodynia, ↑ risk of gallbladder disease & thromboembolic disorders Interactions: ↑ Risk of hyperkalemia W/ ACEIs, ARBs, aldosterone antagonists, heparin, NSAIDs, spirolactone, K+ sparing diuretics, K+ supplements, ↑ effects OF cyclosporine, prednisolone, theophylline; ↓ effects W/ barbiturates, carbamazepine, griseofulvin, modafinil, phenobarbital, phenylbutazone, phenytoin, pioglitazone, rifabutin, rifampin, ritonavir, topiramate, ↑ ↓ St John’s wort Labs: uptake OF T3, T4 sex hormone-binding globulin levels; triglycerides NIPE: Antimineralocorticoid activity comparable to spirolactone 25 mg; in pts taking meds that ↑ K+, monitor serum K+ during 1st treatment cycle; Sunday start regimen or postpartum use requires additional contraceptive methods during 1st cycle; use barrier contraception if taking anticonvulsants; may cause vision changes or ↓ contact lens tolerability; N protection against HIV or STDs; N smoke cigarettes Drotrecogin Alfa (Xigris) [Antithrombotic/Activated Protein C (Recombinant)] Uses: *↓ Mortality in adults w/ severe sepsis (w/ acute organ dysfunction) at high risk of death (eg, determined by APACHE II, www.ncemi.org)* Action: Recombinant human-activated protein C; antithrombotic and anti-inflammatory, unclear mechanism Dose: 24 μg/kg/h, total of 96 h Caution: [C, ?] Contra: Active bleeding, recent stroke/CNS surgery, head trauma/CNS lesion w/ herniation risk, trauma w/ ↑ bleeding risk, epidural catheter, mifepristone Disp: 5-, 20-mg vials SE: Bleeding Notes: Single organ dysfunction & recent surgery may not be at high risk of death irrespective of APACHE II score & therefore not indicated. Percutaneous procedures: Stop inf 2 h before & resume 1 h after; major surgery: stop inf 2 h before & resume 12 h after in absence of bleeding Interactions: ↑ Risk of bleeding W/ plt inhibitors, anticoagulants Labs: ↑ aPTT NIPE: D/C drug 2 h before invasive procedures Duloxetine (Cymbalta) [Antidepressant/SSNRI] WARNING: Antidepressants may ↑ risk of suicidality; consider risks/benefits of use. Closely monitor for clinical worsening, suicidality, or behavior changes Uses: *Depression, DM peripheral neuropathic pain, GAD* Action: Selective serotonin & norepinephrine reuptake inhibitor (SSNRI) Dose: Depression: 40–60 mg/d PO ÷ bid. DM neuropathy: 60 mg/d PO. GAD: 30–60 mg/d max 120 mg/d Caution: [C, ?/–]; Use in 3rd tri; avoid if CrCl <30 mL/min, NAG, w/ fluvoxamine, inhibitors of CYP2D6 (Table 11), TCAs, phenothiazines, type 1C antiarrhythmics (Table 10) Contra: MAOI use w/in 14 d, w/ thioridazine, NAG, hepatic insuff Disp: Caps delayed- release 20, 30, 60 mg SE: N, dizziness, somnolence, fatigue, sweating, xerostomia, constipation, ↓ appetite, sexual dysfunction, urinary hesitancy, HTN Interactions: ↑ Effects OF flecainide, propafenone, phenothiazines, TCAs; ↑ effects W/ cimetidine, fluvoxamine, quinolones; ↑ risk OF hypertensive crisis W/ MAOIs within 14 d of taking duloxetine Labs:?↑ LFTs NIPE:↑ Risk of liver damage W/ EtOH use; N D/C drug abruptly; swallow whole; monitor BP 112 Dutasteride

Dutasteride (Avodart) [Androgen Hormone Inhibitor/BPH Agent] Uses: *Symptomatic BPH* Action: 5α-Reductase inhibitor; ↓ intracellular DHT Dose: 0.5 mg PO/d Caution: [X, –] Hepatic impair; pregnant women should not handle pills Contra: Women & children Disp: Caps 0.5 mg SE: ↑ testosterone, TSH ↑, ↓ PSA levels, impotence, ↓ libido, gynecomastia Interac- tions: ↑ Effects W/ cimetidine, ciprofloxacin, diltiazem, ketoconazole, ritonavir, verapamil Labs: ↓ PSA levels; new baseline PSA @ 6 mo; corrected PSA × 2 NIPE: N Handling by PRG women; take w/o regard to food; no blood donation until 6 mo after D/C Echothiophate Iodine (Phospholine Ophthalmic) [Choline- sterase Inhibitor/Glaucoma Agent] Uses: *Glaucoma* Action: Cholinesterase inhibitor Dose: 1 gtt eye(s) bid w/ 1 dose hs Caution: [C, ?] Con- tra: Active uveal inflammation, inflammatory Dz of iris/ciliary body, glaucoma iridocyclitis Disp: Powder, reconstitute 1.5 mg/0.03%; 3 mg/0.06%; 6.25 mg/0.125%; 12.5 mg/0.25% SE: Local irritation, myopia, blurred vision, ↓ BP, bradycardia Interactions: ↑ Effects W/ cholinesterase inhibitors, pilocarpine, succinylcholine, carbamate or organophosphate insecticides; ↑ effects OF cocaine; ↓ effects W/ anticholinergics, atropine, cyclopentolate, ophthalmic adrenocorticoids NIPE: N Drug 2 wk before surgery if succinylcholine to be administered; keep drug refrigerated; monitor for lens opacities Econazole (Spectazole) [Topical Antifungal] Uses: *Tinea, cutaneous Candida & tinea versicolor Infxns* Action: Topical antifungal Dose: Apply to areas bid (daily for tinea versicolor) for 2–4 wk Caution: [C, ?] Contra: Com- ponent sensitivity Disp: Topical cream 1% SE: Local irritation, pruritus, erythema Interactions: ↓ Effects W/ corticosteroids NIPE: Topical use only; N eye area; early symptom/clinical improvement; complete course to avoid recurrence Eculizumab (Soliris) [Complement Inhibitor] WARNING: ↑ Risk of meningococcal Infxns (give meningococcal vaccine 2 weeks prior to 1st dose and revaccinate per guidelines) Uses: *Rx paroxysmal nocturnal hemoglobinuria* Action: Complement inhibitor Dose: 600 mg IV q7d × 4 wk, then 900 mg IV 5th dose 7 d later, then 900 mg IV q14d Caution: [C; ?] Contra: Active N. meningitides Infxn; if not vaccinated against N. meningitides Disp: 300-mg vial SE: Meningococcal Infxn, HA, nasopharyngitis, N, back pain, Infxns, fatigue, severe hemolysis on D/C NIPE: IV over 35 min (2-h max inf time); monitor for 1 h for S/Sx of inf Rxn Edrophonium (Tensilon, Enlon, Reversol) [Cholinergic Muscle Stimulant/Anticholinesterase] Uses: *Diagnosis of MyG; acute MyG crisis; curare antagonist, reverse of nondepolarizing neuromuscular blockers* Action: Anticholinesterase Dose: Adults. Test for MyG: 2 mg IV in 1 min; if tolerated, give 8 mg IV; (+) test is brief ↑ in strength. Peds. Test for MyG: Total dose 0.2 mg/kg; 0.04 mg/kg test dose; if no Rxn, give remainder in 1-mg increments to 10 mg max; ↓ in renal impair Caution: [C, ?] Contra: GI/GU obst; allergy to Efavirenz, Emtricitabine, Tenofovir 113 sulfite Disp: Inj 10 mg/mL SE: N/V/D, excessive salivation, stomach cramps, ↑ aminotransferases Interactions: ↑ Effects W/ tacrine; ↑ cardiac effects W/ digoxin; ↑ effects OF neostigmine, pyridostigmine, succinylcholine, jaborandi tree, pill-bearing spurge; ↓ effects W/ corticosteroids, procainamide, quinidine Labs: ↑ AST, ALT, serum amylase NIPE: ↑ Risk uterine irritability & premature labor in PRG pts near term; can cause severe cholinergic effects; keep atropine available Efalizumab (Raptiva) [Antipsoriatic/Immunosuppressant] WARNING: Associated w/ serious Infxns, malignancy, thrombocytopenia Uses: Chronic moderate–severe plaque psoriasis Action: MoAb Dose: Adults. 0.7 mg/kg SQ conditioning dose, followed by 1 mg/kg/wk; single doses should not exceed 200 mg Caution: [C, +/–], chronic Infxn, elderly Contra: Admin of most vaccines Disp: 150-mg vial SE: 1st-dose Rxn, HA, worsening psoriasis, ↑ LFT, hemolytic anemia immunosuppressive-related Rxns (see Warning) Interactions: ↑ Risk of Infxn & malignancy W/ immunosuppressive agents; ↓ immune response W/ live virus vaccines; Labs: ↑ Lymphocytes; plts monthly, then every 3 mo & w/ dose ↑; NIPE: Reconstituted soln may be stored for 8 h; monitor for bleeding gums & bruising; minimize 1st-dose Rxn by conditioning dose; pts may be trained in self-admin Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses: *HIV Infxns* Action: Antiretroviral; nonnucleoside RTI Dose: Adults. 600 mg/d PO qhs. Peds. See insert; avoid high-fat meals Caution: [D, ?] CDC recommends HIV-infected mothers not breast-feed Contra: Component sensitivity Disp: Caps 50, 100, 200; 600 mg tab SE: Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions: ↑ Effects W/ritonavir; ↑ effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin; ↓ effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John’s wort; ↓ effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin; may alter effectiveness of OCPs Labs: ↑ LFTs, cholesterol; monitor LFT, cholesterol NIPE: N High—fat foods; take w/o regard to food; use barrier contraception Efavirenz, Emtricitabine, Tenofovir (Atripla) [Combination Antiretroviral] WARNING: Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination with other antiretrovirals Uses: *HIV Infxns* Action: Triple fixed-dose combination antiretroviral Dose: Adults. 1 tab daily on empty stomach; hs dose may ↓ CNS effects Caution: [D, ?] CDC recommends HIV-infected mothers not to breast-feed Contra: <18 y, component sensitivity, w/ astemizole, midazolam, triazolam or ergot derivatives (competition for CYP3A4 by efavirenz could result in serious and/or life-threatening SE) Disp: Tab containing efavirenz 600 mg/emtricitabine 200 mg/tenofovir/300 mg SE: Somnolence, vivid dreams, HA, dizziness, rash, N/V/D, ↓ bone mineral density Interactions: ↑ Effects OF ritonavir, tenofovir, ethinyl estradiol levels ↓ W/ phenobarbital, rifampin, rifabutin, saquinavir, ↓ effects OF indinavir, amprenavir, clarithromycin, 114 Eletriptan methadone, rifabutin, sertraine, statins, saquinavir; monitor warfarin levels Labs: Monitor LFT, cholesterol NIPE: N EtOH; N PRG & breast-feeding; register pregnant patients exposed to this drug at (800) 258-4263; do not use in HIV and Hep B coinfection; see individual agents for additional info Eletriptan (Relpax) [Analgesic/Antimigraine Agent] Uses: *Acute Rx of migraine* Action: Selective serotonin receptor (5-HT1B/1D) agonist Dose: 20–40 mg PO, may repeat in 2 h; 80 mg/24 h max Caution: [C, +] Contra: h/o ischemic heart Dz, coronary artery spasm, stroke or TIA, peripheral vascular Dz, IBD, uncontrolled HTN, hemiplegic or basilar migraine, severe hepatic impair, w/in 24 h of another 5-HT1 agonist or ergot, w/in 72 h of CYP3A4 inhibitors Disp: Tabs 20, 40 mg SE: Dizziness, somnolence, N, asthenia, xerostomia, paresthesias; pain, pressure, or tightness in chest, jaw or neck; serious cardiac events Interac- tions: ↑ Risk of serotonin syndrome W/ SSRIs; ↑ risks of prolonged vasospasms W/ ergot-containing medications Labs: None known NIPE: Not for migraine prevention; N EtOH; N use for more than 3 migraine attacks/mo Emedastine (Emadine) [Antihistamine] Uses: *Allergic conjunctivitis* Action: Antihistamine; selective H1-antagonist Dose: 1 gtt in eye(s) up to qid Caution: [B, ?] Contra: Allergy to ingredients (preservatives benzalkonium, tromethamine) Disp: 0.05% soln SE: HA, blurred vision, burning/stinging, corneal infiltrates/staining, dry eyes, foreign body sensation, hyperemia, keratitis, tearing, pruritus, rhinitis, sinusitis, asthenia, bad taste, dermatitis, discomfort NIPE: N Wear soft contact lens for 15 min after use; do not use contact lenses if eyes are red Emtricitabine (Emtriva) [Antiretroviral/NRTI] WARNING: Class warning for lipodystrophy, lactic acidosis, & severe hepatomegaly Uses: HIV-1 Infxn Action: NRTI Dose: 200 mg cap or 240 mg sol PO daily; ↓ w/ renal impair Caution: [B, –] Risk of liver Dz Contra: Component sensitivity Disp: Soln: 10 mg/mL, 200 mg caps SE: HA, D, N, rash, rare hyperpigmentation of feet & hands, posttreatment exacerbation of hepatitis Notes: 1st one-daily NRTI; caps/sol not equivalent; not rec as monotherapy; screen for HepB, do not use in established HIV and Hep B coinfection Interactions: None noted W/ additional NRTIs Labs: ↑ LFTs, bilirubin, triglycerides, glucose NIPE: Take w/o regard to food; causes redistribution and accumulation of body fat; take w/ other antiretrovirals; not a cure for HIV or prevention of opportunistic Infxns Enalapril (Vasotec) [Antihypertensive/ACEI] Uses: *HTN, CHF, LVD*, DN Action: ACE inhibitor Dose: Adults. 2.5–40 mg/d PO; 1.25 mg IV q6h. Peds. 0.05–0.08 mg/kg/d PO q12–24h; ↓ w/ renal impair Caution: [C (1st tri; D 2nd & 3rd tri), +] D/C immediately once pregnancy detected w/ NSAIDs, K+ supls Contra: Bilateral RAS, angioedema Disp: Tabs 2.5, 5, 10, 20 mg; IV 1.25 mg/mL (1, 2 mL) SE: ↓ BP w/ initial dose (especially w/ diuretics), ↑ K+, nonproductive cough, angioedema Notes: Monitor Cr; D/C diuretic for 2–3 d prior to start Interactions: ↑ Effects W/ loop diuretics; ↑ risk of cough W/ capsaicin; Entacapone 115

↑ effects OF α-blockers, insulin, Li; ↑ risk of hyperkalemia W/ K supl, K-sparing diuretics, salt substitutes, trimethoprim; ↓ effects W/ ASA, NSAIDs, rifampin Labs: May cause ↑ serum K+, direct Coombs test, false + urine acetone NIPE: Several weeks needed for full hypotensive effect Enfuvirtide (Fuzeon) [Antiretroviral/Fusion Inhibitor] WARN- ING: Rarely causes allergy; never rechallenge Uses: *w/ antiretroviral agents for HIV-1 Infxn in treatment-experienced pts with evidence of viral replication despite ongoing antiretroviral therapy* Action: Viral fusion inhibitor Dose: 90 mg (1 mL) SQ bid in upper arm, anterior thigh, or abdomen; rotate site Caution: [B, –] Contra: Previous allergy to drug Disp: 90 mg/mL reconstituted; pt kit w/ monthly supplies SE: Inj site Rxns (in most); pneumonia, D, N, fatigue, insomnia, peripheral neuropathy Interactions: None noted W/ other antiretrovirals Labs: ↑ LFTs, triglycerides; ↓ HMG, Hct, eosinophils NIPE: Does not cure HIV; does not ↓ risk of transmission or prevent opportunistic Infxns; take w/o regard to food; Available only via restricted distribution system; use immediately on recons or refrigerate (24 h max) Enoxaparin (Lovenox) [Anticoagulant/Low Molecular Weight Heparin Derivative] WARNING: Recent or anticipated epidural/ spinal anesthesia ↑ risk of spinal/epidural hematoma w/ subsequent paralysis Uses: *Prevention & Rx of DVT; Rx PE; unstable angina & non-Q-wave MI* Action: LMW heparin; inhibit thrombin by complexing w/ antithrombin III Dose: Adults. Prevention: 30 mg SQ bid or 40 mg SQ q24h. DVT/PE Rx: 1 mg/kg SQ q12h or 1.5 mg/kg SQ q24h. Angina: 1 mg/kg SQ q12h; Ancillary to fibrinolysis in AMI: 30 mg IV bolus, then 1 mg/kg SQ bid (ECC 2005); CrCl <30 mL ↓ to 1/mg/kg SQ daily Peds. Prevention: 0.5 mg/kg SQ q12h. DVT/PE Rx: 1 mg/kg SQ q12h; ↓ dose w/ CrCl <30 mL/min Caution: [B, ?] Not for prophylaxis in prosthetic heart valves Contra: Active bleeding, HIT Ab(+), Cr >2.5 mg/dL men, 2 g/dL women Disp: Inj 10 mg/0.1 mL (30-, 40-, 60-, 80-, 100-, 120-, 150-mg syringes) 300-mg/mL multidose vial SE: Bleeding, hemorrhage, bruising, thrombocytopenia, fever, pain/hematoma at site, ↑ AST/ALT Interactions: ↑ Bleeding effects W/ ASA, anticoagulants, cephalosporins, NSAIDs, penicillin, chamomile, garlic, ginger, ginkgo biloba, feverfew, horse chestnut Labs: ↑ AST, ALT; No effect on bleeding time, plt Fxn, PT, or aPTT; monitor plt for HIT; may monitor antifactor Xa NIPE: Admin deep SQ; N IM Entacapone (Comtan) [Antiparkinsonian Agent/COMT Inhibitor] Uses: *Parkinson Dz* Action: Selective & reversible car- boxymethyl transferase inhibitor Dose: 200 mg w/ each levodopa/carbidopa dose; max 1600 mg/d; ↓ levodopa/carbidopa dose 25% w/ levodopa dose >800 mg Cau- tion: [C, ?] Hepatic impair Contra: Use w/ MAOI Disp: Tabs 200 mg SE: Dyski- nesia, hyperkinesia, N, D, dizziness, hallucinations, orthostatic ↓ BP Interactions: ↑ Effects W/ ampicillin, chloramphenicol cholestyramine, erythromycin, MAOIs, 116 Ephedrine probenecid, rifampin; ↑ risk of arrhythmias & HTN W/ bitolterol, dopamine, dobutamine, epinephrine, isoetharine, methyldopa, norepinephrine Labs: Monitor LFTs NIPE: N D/C abruptly, breast-feed; brownish-orange urine Ephedrine [Vasopressor/Decongestant/Bronchodilator] Uses: *Acute bronchospasm, bronchial asthma, nasal congestion,* ↓ BP, narcolepsy, enuresis, & MyG Action: Sympathomimetic; stimulates α- & β-receptors; bronchodilator Dose: Adults. Congestion: 25–50 mg PO q6h PRN; ↓BP: 25–50 mg IV q5–10min, 150 mg/d max. Peds. 0.2–0.3 mg/kg/dose IV q4–6h PRN Caution: [C, ?/–] Contra: Arrhythmias; NAG Disp: Nasal soln 0.48%, 0.5%, oral capsule: 25, 37.5, 50 mg Inj 50 mg/mL; nasal spray 0.25% SE: CNS stimulation (nervousness, anxiety, trembling), tachycardia, arrhythmia, HTN, xerostomia, dysuria In- teractions: ↑ Effects W/ acetazolamide, antacids, MAOIs, TCAs, urinary alkalinizers; ↑ effects OF sympathomimetics; ↓ response W/ diuretics, methyldopa, reserpine, urinary acidifiers; ↓ effects OF antihypertensives, BBs, dexamethasone, guanethidine Labs: False ↑ urine amino acids; can cause false + amphetamine EMIT NIPE: N EtOH; store away from light/heat; Protect from light; monitor BP, HR, urinary output; take last dose 4–6 h before hs; abuse potential, OTC sales mostly banned/restricted Epinephrine (Adrenalin, Sus-Phrine, EpiPen, EpiPen Jr, others) (EpiPen Jr, others) [Vasopressor/Bronchodilator/Cardiac Stimulant, Local Anesthetic] Uses: *Cardiac arrest, anaphylactic Rxn, bronchospasm, open-angle glaucoma* Action: β-Adrenergic agonist, some a-effects Dose: Adults. 1.0 mg IV push, repeat q3–5min; (0.2 mg/kg max) if 1 mg dose fails. Inf: 30 mg (30 mL of 1:1000 soln) in 250 mL NS or D5W, at 100 mL/h, titrate. ET: 2.0–2.5 mg in 20 mL NS. Profound bradycardia/hypotension: 2–10 μg/min (1 mg of 1:1000 in 500 mL NS, inf 1–5 mL/min) (ECC 2005); Anaphylaxis: 0.3–0.5 mL SQ of 1:1000 dilution, repeat PRN q5–15min to max 1 mg/dose & 5 mg/d. Asthma: 0.1–0.5 mL SQ of 1:1000 dilution, repeat q20-min to 4-h or 1 inhal (met-dose) repeat in 1–2 min or susp 0.1–0.3 mL SQ for extended effect. Peds. ACLS: 1st dose 0.1 mL/kg IV of 1:10,000 dilution, then 0.1 mL/kg IV of 1:1000 dilution q3–5min to response. Anaphylaxis: 0.15–0.3 mg IM depending on wt <30 kg 0.01 mg/kg Asthma: 0.01 mL/kg SQ of 1:1000 dilution q8–12h. Caution: [C, ?] ↓ Bronchodilation with β-blockers Contra: Cardiac arrhythmias, NAG Disp: Inj 1:1000, 1:2000, 1:10,000, 1:100,000; susp for inj 1:200; aerosol 220 μg/spray; 1% inhal soln; EpiPen AutoInjector 1 dose 0.30 mg; EpiPen Jr 0.15 mg SE: CV (tachycardia, HTN, vasoconstriction), CNS stimulation (nervousness, anxiety, trembling), ↓renal blood flow Interactions: ↑ HTN effects W/ α-blockers, BBs, ergot alkaloids, furazolidone, MAOIs; ↑ cardiac effects W/ antihistamines, cardiac glycosides, levodopa, thyroid hormones, TCAs; ↑ effects OF sympathomimetics; ↓ effects OF diuretics, guanethidine, hypoglycemics, methyldopa Labs: ↑ BUN, glucose, & lactic acid with prolonged use NIPE: N OTC inhalation drugs; can give via ET tube if no central line (use 2–2.5 ×IV dose); EpiPen for pt self-use (www.EpiPen.com)) Epoetin Alfa 117

Epinastine (Elestat) [Antihistamine] Uses: Itching w/ allergic conjunctivitis Action: Antihistamine Dose: 1 gtt bid Caution: [C, ?/–] Disp: Soln 0.05% SE: Burning, folliculosis, hyperemia, pruritus, URI, HA, rhinitis, sinusitis, cough, pharyngitis NIPE: Remove contacts before, reinsert in 10 min if eye not red; caution in pregnancy & lactation Epirubicin (Ellence) [Antineoplastic/Anthracycline] WARN- ING: Do not give IM or SQ. Potential cardiotox; severe myelosupp Uses: *Adju- vant therapy for + axillary nodes after resection of primary breast CA*, Actions: Anthracycline cytotoxic agent Dose: Per protocols; ↓ dose w/ hepatic impair Cau- tion: [D, –] Contra: Baseline neutrophil count <1500 cells/mm3, severe myocardial insuff, recent MI, severe arrhythmias, severe hepatic dysfunction, previous anthracyclines Rx to max cumulative dose Disp: Inj 50 mg/25 mL, 200 mg/100 mL SE: Mucositis, N/V/D, alopecia, ↓ BM, cardiotox, secondary AML, tissue necrosis w/ extrav, lethargy Interactions: ↑ Effects W/ cimetidine; ↑ effects OF cytotoxic drugs, radiation therapy; ↑ risk of HF W/ CCBs, trastuzumab; incompatible chemically W/ fluorouracil, heparin Labs:↓ HMG, Hct, neutrophils, plts, WBC NIPE: N Handle if PRG breast-feeding; urine reddish up to 2 d after treatment, use contraception during treatment, burning at inj site indicates infiltration, menstruation may cease permanently Eplerenone (Inspra) [Antihypertensive/Selective Aldos- terone Receptor Antagonist] Uses: *HTN* Action: Selective aldosterone antagonist Dose: Adults: 50 mg PO daily–bid, doses >100 mg/d no benefit w/ ↑ K+; ↓ to 25 mg PO daily if giving w/ CYP3A4 inhibitors Caution: [B, +/–] w/ CYP3A4 inhibitors (Table 11); monitor K+ with ACE inhibitor, ARBs, NSAIDs, K+-sparing diuretics; grapefruit juice, St. John’s wort Contra: K+ >5.5 mEq/L; NIDDM w/ microalbuminuria; SCr >2 mg/dL (males), >1.8 mg/dL (females); CrCl <50 mL/min; w/ K+ supls/K+-sparing diuretics, ketoconazole Disp: Tabs 25, 50, 100 mg SE: HA, dizziness, gynecomastia, D, orthostatic ↓ BP Interactions: ↑ Risk hyperkalemia W/ ACEIs; ↑ risk of toxic effects W/ azole antifungals, erythromycin, saquinavir, verapamil, ↑ effects OF Li; ↓ effects W/ NSAIDs Labs: ↑ K+, cholesterol, triglycerides NIPE: N High- K foods; may cause reversible breast pain or enlargement w/ use; may take 4 wk for full effect Epoetin Alfa [Erythropoietin, EPO] (Epogen, Procrit) [Re- combinant Human Erythropoietin] WARNING: Use lowest dose possible; may be associated with ↑ CV, thromboembolic events and/or mortality; D/C if Hgb >12 g/dL Uses: *CRF associated anemia* zidovudine Rx in HIV-infected pts, CA chemo; ↓ transfusions associated w/ surgery Action: In- duces erythropoiesis Dose: Adults & Peds. 50–150 units/kg IV/SQ 3×/wk; adjust dose q4–6wk PRN. Surgery: 300 units/kg/d × 10 d before to 4 d after; ↓ dose if Hct 36% or Hgb, ↑ > ≅12 g/dL or Hgb ↑ >1 g/dL in 2-wk period; hold dose if Hgb >12 g/dL Caution: [C, +] Contra: Uncontrolled HTN Disp: Inj 2000, 118 Epoprostenol

3000, 4000, 10,000, 20,000, 40,000 units/mL SE: HTN, HA, fatigue, fever, tachycardia, N/V Interactions: None noted Labs: ↑ WBCs, plts; monitor baseline & posttreatment Hct/Hgb, BP, ferritin NIPE: Monitor for access line clotting, N shake vial; refrigerate Epoprostenol (Flolan) [Antihypertensive] Uses: *Pulm HTN* Action: Dilates pulm/systemic arterial vascular beds; ↓ plt aggregation Dose: Initial 2 ng/kg/min; ↑ by 2 ng/kg/min q15min until dose-limiting SE (CP, dizziness, N/V, HA, ↓ BP, flushing); IV cont inf 4 ng/kg/min < maximum-tolerated rate; adjust based on response; see package insert Caution: [B, ?] ↑ Tox w/ diuretics, vasodilators, acetate in dialysis fluids, anticoagulants Contra: Chronic use in CHF 2nd-deg, if pt develops pulm edema w/ dose initiation, severe LVSD Disp: Inj 0.5, 1.5 mg SE: Flushing, tachycardia, CHF, fever, chills, nervousness, HA, N/V/D, jaw pain, flulike Sxs Interactions: ↑ Risk of bleeding W/ anticoagulants, antiplts; ↑ effects OF digoxin; ↓ BP W/ antihypertensives, diuretics, vasodilators NIPE: N Mix or administer w/ other drugs; Abrupt D/C can cause rebound pulm HTN; monitor bleeding w/ other antiplt/anticoagulants; watch ↓ BP W/ other vasodilators/diuretics Eprosartan (Teveten) [Antihypertensive/ARB] Uses: *HTN*, DN, CHF Action: ARB Dose: 400–800 mg/d single dose or bid Caution: [C (1st tri); D (2nd & 3rd tri), D/C immediately when pregnancy detected] w/ Lithium, ↑ K+ with K+-sparing diuretics/supls/high-dose trimethoprim Contra: Bilateral RAS, 1st-deg aldosteronism Disp: Tabs 400, 600 mg SE: Fatigue, depression, URI, UTI, abd pain, rhinitis/pharyngitis/cough, hypertriglyceridemia Inter- actions: ↑ Risk of hyperkalemia W/ K-sparing diuretics, K supls, trimethoprim; ↑ effects OF Li Labs: ↑ BUN, triglycerides; ↓ HMG, Hct, neutrophils NIPE: Moni- tor CBC & differential, renal Fxn; N PRG, breast-feeding Eptifibatide (Integrilin) [Antiplatelet Agent] Uses: *ACS, PCI* Action: Glycoprotein IIb/IIIa inhibitor Dose: 180 μg/kg IV bolus, then 2 μg/ kg/min cont inf; ↓ in renal impair (SCr >2 mg/dL, <4 mg/dL: 135 μg/kg bolus & 0.5 μg/kg/min inf); ACS: 180 μg/kg IV bolus then 2 μg/kg/min. PCI: 135 μg/kg IV bolus then 0.5 μg/kg/min; bolus again in 10 min (ECC 2005) Caution: [B, ?] Mon- itor bleeding w/ other anticoagulants Contra: Other GPIIb/IIIa inhibitors, h/o abnormal bleeding, hemorrhagic stroke (within 30 d), severe HTN, major surgery (within 6 wk), plt count <100,000 cells/mm3, renal dialysis Disp: Inj 0.75, 2 mg/mL SE: Bleeding, ↓ BP, inj site Rxn, thrombocytopenia; Interactions: ↑ Bleeding W/ ASA, cephalosporins, clopidogrel, heparin, NSAIDs, thrombolytics, ticlopidine, warfarin, evening primrose oil, feverfew, garlic, ginger, ginkgo biloba, ginseng, Labs: ↓ Plts; Monitor bleeding, coags, plts, SCr, activated coagulation time (ACT) with prothrombin consumption index (keep ACT 200–300 sec) Erlotinib (Tarceva) [Antineoplastic] Uses: *NSCLC after 1 chemo agent fails* Action: HER2/EGFR tyrosine kinase inhibitor Dose: 150 mg/d PO 1 h ac or 2 h pc; ↓ (in 50-mg decrements) w/ severe Rxn or w/ CYP3A4 inhibitors Erythromycin 119

(Table 11); per protocols Caution: [D, ?/–]; w/ CYP3A4 (Table 11) inhibitors Disp: Tabs 25, 100, 150 mg SE: Rash, N/V/D, anorexia, abd pain, fatigue, cough, dyspnea, edema, stomatitis, conjunctivitis, pruritus, dry skin, Infxn, interstitial lung disease Interactions: ↑ Drug plasma levels W/ CYP3A4 inhibitors (clarithromycin, ritonavir, ketoconazole); ↓ drug plasma levels W/ CYP3A4 inducers (carbamazepine, phenytoin, phenobarbital, St John’s wort); ↑ risk of bleeding W/ anticoagulants, NSAIDs; Labs: Monitor LFTs, PT, INR; may ↑ INR w/ warfarin NIPE: N PRG or lactation; use adequate contraception; ↑ drug metabolism in smokers Ertapenem (Invanz) [Anti-infective/Carbapenem] Uses: *Com- plicated intra-abd, acute pelvic, & skin Infxns, pyelonephritis, community-acquired pneumonia* Action: A carbapenem; β-lactam antibiotic, ↓ cell wall synth. Spec- trum: Good gram (+/–) & anaerobic coverage, not Pseudomonas sp, PCN-resistant pneumococci, MRSA, Enterococcus sp, β-lactamase (+) H. influenza, Mycoplasma sp, Chlamydia sp Dose: Adults. 1 g IM/IV daily; 500 mg/d in CrCl <30 mL/min Peds: 3 mo–12 y: 15 mg/kg bid IM/IV, max 1 g/d Caution: [C, ?/–] seizure h/o, CNS disorders, β-lactam & multiple allergies, Probenecid ↓ renal clearance Con- tra: component hypersensitivity or amide anesthetics Disp: Inj 1 g/vial SE: HA, N/V/D, inj site Rxns, thrombocytosis,; Notes: Can give IM × 7 d, IV × 14 d; 137 mg Na+ (6 mEq)/g ertapenem Interactions: ↑ Effects W/ probenecid Labs: ↑ LFTs, glucose, K+, Cr, PT, PTT, RBCs, urine WBCs NIPE: Monitor for super Infxn Erythromycin (E-Mycin, E.E.S., Ery-Tab, EryPed, Ilotycin) [Antibiotic/Macrolide] Uses: *Bacterial Infxns; bowel prep*; ↑ GI motility (prokinetic); *acne vulgaris* Action: Bacteriostatic; interferes w/ protein synth. Spectrum: Group A streptococci (S. pyogenes), S. pneumoniae, N. meningitides, N. gonorrhea (if PCN-allergic), Legionella sp, M. pneumoniae Dose: Adults. Base 250–500 mg PO q6–12h or ethylsuccinate 400–800 mg q6–12h; 500 mg–1 g IV q6h. Prokinetic: 250 mg PO tid 30 min ac. Peds. 30–50 mg/kg/d PO ÷ q6–8h or 20–40 mg/kg/d IV ÷ q6h, max 2 g/d Caution: [B, +] ↑ tox of carbamazepine, cyclosporine, digoxin, methylprednisolone, theophylline, felodipine, warfarin, simvastatin/lovastatin; ↓ sildenafil dose w/ use Contra: Hepatic impair, preexisting liver Dz (estolate), use with pimozide Disp: Lactobionate (Ilotycin): Powder for inj: 500 mg, 1 g. Base: Tabs 250, 333, 500 mg; caps 250 mg. Estolate (Ilosone): Susp 125, 250 mg/5 mL. Stearate (Erythrocin): Tabs 250, 500 mg. Eth- ylsuccinate (EES, EryPed): Chew tabs 200 mg; tabs 400 mg; susp 200, 400 mg/5 mL SE: HA, abd pain, N/V/D; [QT prolongation, torsades de pointes, ventricular arrhythmias/tachycardias (rarely)]; cholestatic jaundice (estolate) Notes: 400 mg ethylsuccinate = 250 mg base/estolate; lactobionate contains benzyl alcohol (caution in neonates) Interactions: ↑ Effects W/ amprenavir, indinavir, ritonavir, saquinavir, grapefruit juice; ↑ effects OF alprazolam, benzodiazepines, buspirone, carbamazepine, clozapine, colchicines, cyclosporine, digoxin, felodipine, lovastatin, midazolam, quinidine, sildenafil, simvastatin, tacrolimus, theophylline, triazolam, valproic acid; ↑ QT W/ astemizole, cisapride; ↓ effects OF penicillin, 120 Erythromycin & Benzoyl Peroxide zafirlukast Labs: ↑ LFTs, eosiniophils, neutrophils, plts; ↓ bicarbonate levels NIPE: Take w/ food if GI upset, monitor for super Infxn & ototox Erythromycin & Benzoyl Peroxide (Benzamycin) [Anti-infective, Macrolide/Keratolytic] Uses: *Topical for acne vulgaris* Action: Macrolide antibiotic w/ keratolytic Dose: Apply bid (AM & PM) Caution: [C, ?] Contra: Component sensitivity Disp: Gel erythromycin 30 mg/benzoyl peroxide 50 mg/g SE: Local irritation, dryness Erythromycin & Sulfisoxazole (Eryzole, Pediazole) [Anti- infective, Macrolide/Sulfonamide] Uses: *Upper & lower resp tract; bacterial Infxns; H. influenzae otitis media in children*; Infxns in PCN-allergic pts Action: Macrolide antibiotic w/ sulfonamide Dose: Adults. Based on erythromycin content; 400 mg erythromycin/1200 mg sulfisoxazole PO q6h. Peds > 2 mo. 40–50 mg/kg/d erythromycin & 150 mg/kg/d sulfisoxazole PO ÷ q6h; max 2 g/d erythromycin or 6 g/d sulfisoxazole × 10 d; ↓ in renal impair Caution: [C (D if near term), +] w/ PO anticoagulants, MRX, hypoglycemics, phenytoin, cyclosporine Contra: Infants <2 mo Disp: Susp erythromycin ethylsuccinate 200 mg/sulfisoxazole 600 mg/5 mL (100, 150, 200 mL) SE: GI upset Additional Interactions: ↑ Effects of sulfonamides W/ ASA, diuretics, NSAIDs, probenecid Labs: False + urine protein NIPE: ↑ Risk of photosensitivity—use sunscreen, ↑ fluid intake Erythromycin, Ophthalmic (Ilotycin Ophthalmic) [Anti-infective, Macrolide, Opthalmic agent] Uses: *Conjunctival/corneal In- fxns* Action: Macrolide antibiotic Dose: 1/2 in. 2–6 × /d Caution: [B, +] Contra: Erythromycin hypersensitivity Disp: 0.5% oint SE: Local irritation NIPE: May cause burning, stinging, blurred vision Erythromycin, Topical (A/T/S, Eryderm, Erycette, T-Stat) [Topical Anti-infective, Macrolide] Uses: *Acne vulgaris* Action: Macrolide antibiotic Dose: Wash & dry area, apply 2% product over area bid Caution: [B, +] Contra: Component sensitivity Disp: Soln 1.5%, 2%; gel 2%; pads & swabs 2% SE: Local irritation Escitalopram (Lexapro) [Antidepressant/SSRI] WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: Depression, anxiety Action: SSRI Dose: Adults. 10–20 mg PO daily; 10 mg/d in elderly & hepatic impair Caution: [C, +/–] Serotonin synd (Table 12) Contra: w/ or w/in 14 d of MAOI Disp: Tabs 5, 10, 20 mg; soln 1 mg/mL SE: N/V/D, sweating, insomnia, dizziness, xerostomia, sexual dysfunction Interactions: ↑ Risk of serotonin syndrome W/ linezolid; ↑ risk of bleeding W/ anticoagulants, ASA, NSAIDs; may ↑ CNS effects W/ CNS depressants NIPE: N D/C abruptly; may take up to 2–4 wk for full effects; take w/o regard to food; may cause ↑ appetite & wt gain Esmolol (Brevibloc) [Antiarrhythmic/BB] Uses: *SVT & noncom- β pensatory sinus tachycardia, AF/flutter* Action: 1-Adrenergic blocker; class II antiarrhythmic Dose: Adults & Peds. Initial 500 μg/kg load over 1 min, then Esterified Estrogens 121

50 μg/kg/min × 4 min; if inadequate response, repeat load & maint inf of 100 μg/kg/min × 4 min; titrate by repeating load, then incremental ↑ in the maint dose of 50 μg/kg/min for 4 min until desired HR reached or ↓ BP; average dose 100 μg/kg/min; 0.5 mg/kg over 1 min, then 0.05 mg/kg/min (ECC 2005) Caution: [C (1st tri; D 2nd or 3rd tri), ?] Contra: Sinus bradycardia, heart block, uncompensated CHF, cardiogenic shock, ↓ BP Disp: Inj 10, 20, 250 mg/mL; premix inf 10 mg/mL SE: ↓ BP; bradycardia, diaphoresis, dizziness Interaction: ↑ Effects W/ verapamil; ↑ effects OF digoxin, antihypertensives, nitrates; ↑ HTN W/ amphetamines, cocaine, ephedrine, epinephrine, MAOIs, norepinephrine, phenylephrine, pseudoephedrine; ↓ effects OF glucagons, insulin, hypoglycemics, theophylline; ↓ effects W/ NSAIDs, thyroid hormones Labs: ↑ Glucose, cholesterol NIPE: Monitor BS of pts w/ DM; pain on inj.; hemodynamic effects back to baseline w/in 30 min after D/C inf Esomeprazole (Nexium) [Gastric Acid Inhibitor/Proton Pump Inhibitor] Uses: *Short-term (4–8 wk) for erosive esophagitis/GERD; H. pylori Infxn in combo with antibiotics* Action: Proton pump inhibitor, ↓ gastric acid Dose: Adults. GERD/erosive gastritis: 20–40 mg/d PO × 4–8 wk; 20–40 mg IV 10–30 min inf or >3 min IV push, 10 d max; Maint: 20 mg/d PO. H. pylori Infxn: 40 mg/d PO, plus clarithromycin 500 mg PO bid & amoxicillin 1000 mg bid for 10 d Caution: [B, ?/–] Contra: Component sensitivity Disp: Caps 20, 40 mg; IV 20, 40 mg SE: HA, D, abd pain Notes: Do not chew; may open capsule & sprinkle on ap- plesauce Interactions: ↑ Effects W/ amoxicillin, clarithromycin; ↑ effects OF benzodiazepines, warfarin ; ↓ effects OF digoxin, ketoconazole, iron salts Labs:↑ SCr, uric acid, LFTs, HMG, WBCs, plts, K+, thyroxine levels NIPE: Take drug 1 h before food; N EtOH Estazolam (Prosom) [C-IV] [Hypnotic/Benzodiazepine] Uses: *Short-term management of insomnia* Action: Benzodiazepine Dose: 1–2 mg PO qhs PRN; ↓ in hepatic impair/elderly/debilitated Caution: [X, –] ↑ effects w/ CNS depressants Contra: PRG Disp: Tabs 1, 2 mg SE: Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions: ↑ Effects W/ amoxicillin, clarithromycin; ↑ effects OF diazepam, phenytoin, warfarin; ↓ effects W/ food; ↓ effects OF azole antifungals, digoxin Labs: ↑ LFTs, NIPE: Take at least 1 h ac; May cause psychological/physical dependence; avoid abrupt D/C after prolonged use Esterified Estrogens (Estratab, Menest) [Estrogen Supplement] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Vasomotor Sxs or vulvar/vaginal atrophy w/ menopause*; female hypogonadism, Pca, prevent osteoporosis Action: Estrogen supl Dose: Menopausal vasomotor Sx: 0.3–1.25 mg/d, cyclically 3 wk on, 1 wk off; add progestin 10–14 d w/ 28-d cycle w/ uterus intact; Vulvovaginal atrophy: Same regimen except use 0.3–1.25 mg; Hypogonadism: 2.5–7.5 mg/d PO × 20 d, off × 10 d; add progestin 10–14 d w/ 28-d cycle w/ uterus intact Caution: [X, –] Contra: Undiagnosed 122 Esterified Estrogens + Methyltestosterone genital bleeding, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, PRG, severe hepatic Dz Disp: Tabs 0.3, 0.625, 1.25, 2.5 mg SE: N, HA, bloating, breast enlargement/tenderness, edema, venous thromboembolism, hypertriglyceridemia, gallbladder Dz Notes: Use lowest dose for shortest time (see WHI data www.whi.org) Interactions: ↑ Effects OF corticosteroids, cyclosporine, TCAs, theophylline, caffeine, tobacco; ↓ effects W/ barbiturates, phenytoin, rifampin; ↓ effects OF anticoagulants, hypoglycemics, insulin, tamoxifen Labs: ↑ Prothrombin & factors VII, VIII, IX, X, plt aggrega- ↓ tion, thyroid-binding globulin, T4, triglycerides; antithrombin III, folate NIPE: N PRG, breast-feeding Esterified Estrogens + Methyltestosterone (Estratest, Es- tratest HS, Syntest DS, HS) [Estrogen & Androgen Supple- ment] WARNING: ↑ Risk of dementia in postmenopausal women, unopposed estrogens may ↑ risk of endometrial carcinoma in postmenopausal women Uses: *Vasomotor Sxs*; postpartum breast engorgement Action: Estrogen & androgen supl Dose: 1 tab/d × 3 wk, 1 wk off Caution: [X, –] Contra: Genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, PRG Disp: Tabs (estrogen/methyltestosterone) 0.625 mg/1.25 mg, 1.25 mg/2.5 mg SE: N, HA, bloating, breast enlargement/tenderness, edema, ↑ triglycerides, venous thromboembolism, gallbladder Dz Notes: Use lowest dose for shortest time; (see WHI data www.whi.org) Additional Interactions: ↑ Effects OF insulin; ↓ effects OF oral anticoagulants Estradiol (Estrace, others) [Estrogen Supplement] Uses: *At- rophic vaginitis, vasomotor Sxs associated w/ menopause, osteoporosis* Action: Estrogen supl Dose: PO: 1–2 mg/d, adjust PRN to control Sxs. Vaginal cream: 2–4 g/d × 2 wk, then 1 g 1–3 ×/wk Caution: [X, –] Contra: Genital bleeding of unknown cause, breast CA, porphyria, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis; recent MI; hepatic impair Disp: Ring, 0.05, 0.1, 2 mg; gel 0.061%; tabs 0.5, 1, 2 mg; vaginal cream 0.1 mg/g SE: N, HA, bloating, breast enlargement/tenderness, edema, ↑ triglycerides, venous thromboembolism, gallbladder Dz Interactions: ↑ Effects W/ grapefruit juice; ↑ effects OF corticosteroids, cyclosporine, TCAs, theophylline, caffeine, tobacco; ↓ effects W/ barbiturates, carbamazepine, phenytoin, primidone, rifampin; ↓ effects OF clofibrate, hypoglycemics, insulin, tamoxifen, warfarin Labs: ↑ Prothrombin & factors ↓ VII, VIII, IX, X, plt aggregation, thyroid-binding globulin, T4, triglycerides; antithrombin III, folate NIPE: N PRG, breast-feeding Estradiol gel (Elestrin) [Estrogen Supplement] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Postmenopausal vasomotor symptoms* Action: Estrogenic Dose: Apply 0.87–1.7 g to skin daily; add progestin × 10–14 d/28-d cycle w/ intact uterus; use lowest effective estrogen dose Caution: [C, ?] Contra: breast CA, estrogen-dependent Estradiol/Norethindrone Acetate 123 tumors, thromboembolic disorders, recent MI, PRG, severe hepatic Dz Disp: 0.87 g gel = 0.52 mg estradiol/pump SE: Thromboembolic events, MI, stroke, ↑ BP, breast/ovarian/endometrial CA, site Rxns, vag spotting, breast changes, abd bloating, cramps, HA, fluid retention NIPE: Apply to upper arm, wait >25 min before sunscreen; avoid concomitant use for >7 d; BP, breast exams Estradiol Cypionate & Medroxyprogesterone Acetate (Lunelle) [Estrogen & Progestin Supplement] WARNING: Cigarette smoking ↑ risk of serious CV side effects from contraceptives containing estrogen. This risk ↑ with age & with heavy smoking (>15 cig/d) & is quite marked in women >35 y. Women who use Lunelle should be strongly advised not to smoke Uses: *Contraceptive* Action: Estrogen & progestin Dose: 0.5 mL IM (deltoid, ant thigh, buttock) monthly, do not exceed 33 d Caution: [X, M] HTN, gallbladder Dz, ↑ lipids, migraines, sudden HA, valvular heart Dz with comps Contra: PRG, heavy smokers >35 y, DVT, PE, cerebro/CV Dz, estrogen-dependent neoplasm, undiagnosed AUB, porphyria, hepatic tumors, cholestatic jaundice Disp: Estradiol cypionate (5 mg), medroxyprogesterone acetate (25 mg) single-dose vial or syringe (0.5 mL) SE: Arterial thromboembolism, HTN, cerebral hemorrhage, MI, amenorrhea, acne, breast tenderness; see Estradiol Additional Interactions: ↓ Effects W/ aminoglutethimide NIPE: Start w/in 5 d of menstruation Estradiol, Transdermal (Estraderm, Climara, Vivelle, Vivelle Dot) [Estrogen Supplement] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Severe menopausal vasomotor Sxs; female hypogonadism* Action: Estrogen supl Dose: Start 0.0375–0.05 mg/d patch–2 × wk based on product; adjust PRN to control Sxs; w/ intact uterus cycle 3 wk on 1 wk off or use cyclic progestin 10–14 d Caution: [X, –] See estradiol Contra: PRG, AUB, porphyria, breast CA, estrogen-dependent tumors, h/o thrombophlebitis, thrombosis Disp: TD patches (mg/24 h) 0.025, 0.0375, 0.05, 0.06, 0.075, 0.1 SE: N, bloating, breast enlargement/tenderness, edema, HA, hypertriglyceridemia, gallbladder Dz; see Estradiol Additional NIPE: Rotate application sites; do not apply to breasts, place on trunk Estradiol/Levonorgestrel transdermal (Climara Pro) [Estro- gen & Progesterone Supplement] WARNING: Do not use in the prevention of CV Dz or dementia Uses: *Menopausal vasomotor Sx; prevent postmenopausal osteoporosis* Action: Estrogen and progesterone Dose: 1 patch 1 ×/wk Caution: [X, –] w/ ↓ thyroid Contra: AUB, estrogen sens tumors, h/o thromboembolism, liver impair, PRG, hysterectomy Disp: Pro 0.045 mg/0.015/mg d patch SE: Site Rxn, vag bleed/spotting, breast changes, abd bloating/cramps, HA, retention fluid, edema, ↑ BP NIPE: Apply lower abd; for osteoporosis give Ca+2/vitamin D supl; follow breast exams Estradiol/Norethindrone Acetate (Femhrt, Activella) [Estro- gen & Progesterone Supplement] WARNING: Estrogens & progestins should not be used for the prevention of CV Dz or dementia; the WHI study 124 Estramustine Phosphate reported ↑ risks of MI, breast CA, & DVT in postmenopausal women during 5 y of treatment with estrogens combined with medroxyprogesterone acetate relative to placebo Uses: *Vasomotor Sxs associated w/ menopause; prevent osteoporosis* Action: Estrogen/progestin hormone replacement; plant derived Dose: 1 tab/d start w/ lowest dose combo Caution: [X, –] w/ ↓ Ca+2/thyroid Contra: PRG; h/o breast CA; estrogen-dependent tumor; abnormal genital bleeding; h/o DVT, PE, or related disorders; recent (w/in past year) arterial thromboembolic Dz (CVA, MI) Disp: Femhrt tabs 2.5/0.5, 5 μg/1 mg; Activella tabs 1.0/0.5, 0.5 mg/0.1 mg SE: Throm- bosis, dizziness, HA, libido changes, insomnia, emotional stability, breast pain NIPE: Use in women w/ intact uterus; caution in heavy smokers Estramustine Phosphate (Estracyt, Emcyt) [Antimicrotubule Agent] Uses: *Advanced PCa* Action: Antimicrotubule agent; weak estrogenic & antiandrogenic activity Dose: 14 mg/kg/d in 3–4 ÷ doses; on empty stomach, no dairy products Caution: [Not used in females] Contra: Active thrombophlebitis or thromboembolic disorders Disp: Caps 140 mg SE: N/V, exacerbation of preexisting CHF, edema, hepatic disturbances, thrombophlebitis, MI, PE, gynecomastia in 20–100% Interactions: ↓ Effects W/ antacids, Ca supls, Ca-containing foods; ↓ effects OF anticoagulants NIPE: Take on empty stomach, several wk may be needed for full effects, store in refrigerator Estrogen, Conjugated (Premarin) [Estrogen/Hormone] WARNING: Should not be used for the prevention of CV Dz or dementia. The WHI reported ↑ risk of MI, stroke, breast CA, PE, & DVT when combined with methoxyprogesterone over 5 y of Rx; ↑ risk of endometrial CA, unopposed estrogens, ↑ risk of dementia in premenopausal women Uses: *Moderate–severe menopausal vasomotor Sxs; atrophic vaginitis; palliative advanced CAP; prevent & Tx of estrogen-deficiency osteoporosis* Action: Estrogen hormonal replacement Dose: 0.3–1.25 mg/d PO cyclically; prostatic CA 1.25–2.5 mg PO tid; Caution: [X, –] Contra: Severe hepatic impair, genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombosis, thrombophlebitis, recent MI Disp: Tabs 0.3, 0.625, 0.9, 1.25, 2.5 mg; inj 25 mg/mL, vag cream 0.625 mg/g SE: ↑ Risk of endometrial CA, gallbladder Dz, thromboembolism, HA, & possibly breast CA; generic products not equivalent Interactions: ↑ Effects OF corticosteroids, cyclosporine, TCAs, theophylline, tobacco; ↓ effects OF anticoagulants, clofibrate; ↓ effects W/ barbiturates, carbamazepine, phenytoin, rifampin Labs: ↑ Prothrombin & factors VII, VIII, IX, X, plt aggregation, ↓ N thyroid-binding globulin, T4, triglycerides; antithrombin III, folate NIPE: PRG, breast-feeding Estrogen, Conjugated Synthetic (Cenestin, Enjuvia) [Estro- gen/Hormone] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Vasomotor menopausal Sxs, vulvovaginal atrophy, prevent postmenopausal osteoporosis* Action: Multiple estrogen hormonal replacement Dose: For all w/ intact uterus progestin × 10–14 d/28-d cycle; Eszopiclone 125

Vasomotor 0.3–1.25 mg (Enjuvia) 0.625–1.25 mg (Cenestin) PO daily; Vaginal atrophy 0.3 mg/d; osteoporosis (Cenestin) 0.625 mg/d Caution: [X, –] Contra: See estrogen, conjugated Disp: Tabs Cenestin 0.3, 0.45, 0.625, 0.9 mg; Enjuvia ER 0.3, 0.45, 0.625, 1.25 mg SE: ↑ risk endometrial/breast CA, gallbladder Dz, thromboembolism; see Estrogen, Conjugated Estrogen, Conjugated + Medroxyprogesterone (Prempro, Premphase) [Estrogen/Progestin Hormones] WARNING: Should not be used for the prevention of CV Dz or dementia; ↑ risk of dementia in premenopausal women; the WHI study reported ↑ risk of MI, stroke, breast CA, PE, & DVT over 5 y of Rx Uses: *Moderate–severe menopausal vasomotor Sxs; atrophic vaginitis; prevent postmenopausal osteoporosis* Action: Hormonal replacement Dose: Prempro 1 tab PO daily; premphase 1 tab PO daily Caution: [X, –] Contra: Severe hepatic impair, genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombosis, thrombophlebitis Disp: (As estrogen/medroxyprogesterone) Prempro: Tabs 0.625/2.5, 0.625/5 mg; Premphase: Tabs 0.625/0 (d 1–14) & 0.625/5 mg (d 15–28) SE: Gall- bladder Dz, thromboembolism, HA, breast tenderness Notes: See WHI www.whi.org; see Estrogen, Conjugated Additional Interactions: ↓ Effects W/ aminoglutethimide Estrogen, Conjugated + Methylprogesterone (Premarin + Methylprogesterone) [Estrogen & Androgen Hormones] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Menopausal vasomotor Sxs; osteoporosis* Action: Estrogen & androgen combo Dose: 1 tab/d Caution: [X, –] Contra: Severe hepatic impair, AUB, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombosis, thrombophlebitis Disp: Tabs 0.625 mg estrogen, conjugated, & 2.5 or 5 mg of methylprogesterone SE: N, bloating, breast enlargement/tenderness, edema, HA, hypertriglyceridemia, gallbladder Dz; see Estrogen, Conjugated Estrogen, Conjugated + Methyltestosterone (Premarin + Methyltestosterone) [Estrogen & Androgen Hormones] WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk of endometrial CA Uses: *Moderate–severe menopausal vasomotor Sxs*; postpartum breast engorgement Action: Estrogen & androgen combo Dose: 1 tab/d × 3 wk, then 1 wk off Caution: [X, –] Contra: Severe hepatic impair, genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis Disp: Tabs (estrogen/ methyltestosterone) 0.625 mg/5 mg, 1.25 mg/10 mg SE: N, bloating, breast enlargement/tenderness, edema, HA, hypertriglyceridemia, gallbladder Dz; see Estrogen, Conjugated Additional Interac- tions: ↑ Effects OF insulin Eszopiclone (Lunesta) [C-IV] [Hypnotic/Nonbenzodiazepine] Uses: *Insomnia* Action: Nonbenzodiazepine hypnotic Dose: 2–3 mg/d hs Elderly: 1–2 mg/d hs; w/ hepatic impair/use w/ CYP3A4 inhibitor (Table 11): 1 mg/d hs Caution: 126 Etanercept

[C, ?/–] Disp: Tabs 1, 2, 3 mg SE: HA, xerostomia, dizziness, somnolence, hallucinations, rash, Infxn, unpleasant taste, anaphylaxis, angioedema Interactions: ↑ Effects W/ itraconazole, ketoconazole, ritonavir; ↑ CNS effects W/ CNS depressants; ↓ effects W/ rifampin NIPE: High-fat meals ↓ absorption Etanercept (Enbrel) [Antirheumatic/TNF Blocker] Uses: *Re- duces Sxs of RA in pts who fail other DMARD*, Crohn Dz Action: Binds TNF Dose: Adults. RA 50 mg sc weekly or 25 mg sc 2×/wk (separated by at least 72–96 h). Peds 4–17 y. 0.8 mg/kg/wk (max 50 mg/wk) or 0.4 mg/kg (max 25 mg/dose) twice weekly 72–96 h apart Caution: [B, ?] w/ predisposition to Infxn (ie, DM) Contra: Active Infxn; Disp: Inj 25 mg/vial, 50 mg/mL SE: HA, rhinitis, inj site Rxn, URI Interactions: ↓ Response to live virus vaccine NIPE: Rotate inj sites; N live vaccines Ethambutol (Myambutol) [Antitubercular Agent] Uses: *Pulm TB* & other mycobacterial Infxns, MAC Action: ↓ RNA synth Dose: Adults & Peds >12 y. 15–25 mg/kg/d PO single dose; ↓ in renal impair, take w/ food, avoid antacids Caution: [B, +] Contra: Unconscious patients, optic neuritis Disp: Tabs 100, 400 mg SE: HA, hyperuricemia, acute gout, abd pain, ↑ LFTs, optic neuritis, GI upset Interactions: ↑ Neurotox W/ neurotoxic drugs; ↓ effects W/ Al salts NIPE: Monitor visual acuity Ethinyl Estradiol (Estinyl, Feminone) [Estrogen Supplement] Uses: *Menopausal vasomotor Sxs; female hypogonadism* Action: Estrogen supl Dose: 0.02–1.5 mg/d ÷ daily–tid Caution: [X, –] Contra: Severe hepatic impair; genital bleeding of unknown cause, breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis Disp: Tabs 0.02, 0.05, 0.5 mg SE: N, bloating, breast enlargement/tenderness, edema, HA, hypertriglyceridemia, gallbladder Dz Interactions: ↑ Effects OF corticosteroids; ↓ effects W/ barbiturates, carbamazepine, hypoglycemics, insulin, phenytoin, primidone, rifampin, ↓ effects OF anticoagulants, tamoxifen Labs: ↑ Prothrombin & factors VII, VIII, IX, X, plt ag- ↓ gregation, thyroid-binding globulin, T4, triglycerides; antithrombin III, folate NIPE: N PRG, breast-feeding Ethinyl Estradiol & Drospirenone (YAZ) [Estrogen & Prog- estin Supplement] WARNING: Cigarette smoking & use of estrogen- based OCPs have ↑ risk of serious cardiovascular side effects; risk ↑ w/ age (esp >35 y) and smoking >15 cig/d Uses: Oral contraception; premenstrual dysphoric disorder Action: Suppresses ovulation by imitating the feedback inhibition of endogenous estrogen and progesterone on the pituitary and hypothalamus Dose: 1 tab PO OD × 28 d, repeat Caution: [X, –], has antimineralocorticoid activity w/ potential hyperkalemia in renal insuff, adrenal insuff, hepatic insuff Contra: Pts w/ renal insuff, hepatic impair, adrenal insuff, DVT, PE, CVD, CAD, estrogen-dependent neoplasms, abnormal uterine bleeding, PRG, heavy smokers >35 y Disp: Ethinyl estradiol (20 μg), drospirenone (3 mg) 28-d pack has 24 active tabs & 4 inert tabs SE: Hyperkalemia, HTN, N, V, HA, breakthrough bleeding, amenorrhea, mastodynia, Ethinyl Estradiol/Levonorgestrel 127

↑ risk of gallbladder Dz & thromboembolic disorders Interactions: ↑ Risk OF hyperkalemia W/ ACEIs, ARBs, aldosterone antagonists, heparin, NSAIDs, spirolactone, K+ sparing diuretics, K+ supplements, ↑ effects OF cyclosporine, prednisolone, theophylline; ↓ effects W/ barbiturates, carbamazepine, griseofulvin, modafinil, phenobarbital, phenylbutazone, phenytoin, pioglitazone, rifabutin, ri- ↑ ↓ fampin, ritonavir, topiramate, St John’s wort Labs: Uptake OF T3, T4 sex hormone-binding globulin levels; triglycerides NIPE: Antimineralocorticoid activity comparable to spirolactone 25 mg; in pts taking meds that ↑ K+ monitor serum K+during 1st Rx cycle; Sunday start regimen or postpartum use requires additional contraceptive methods during 1st cycle; use barrier contraception if taking anticonvulsants; may cause vision changes or ↓ contact lens tolerability; N protection against HIV or STDs; N smoke cigarettes Ethinyl Estradiol & Levonorgestrel (Preven) [Estrogen & Progestin Supplements] Uses: *Emergency contraceptive* (“morning- after pill”); prevent PRG (contraceptive failure, unprotected intercourse) Actions: Estrogen & progestin; interferes with implantation Dose: 4 tabs, take 2 tabs q12h × 2 (w/in 72 h of intercourse) Caution: [X, M] Contra: Known/suspected PRG, AUB, h/o or current DVT/PE, stroke, MI CVD, CAD; severe HTN; severe HA with focal neurological Sx; breast or endometrial CA; estrogen-dependent neoplasms; undiagnosed abnormal genital bleeding; hepatic dysfn; jaundice; major surgery with prolonged immobilization; heavy smoking if >35 y Disp: Kit: Ethinyl estradiol (0.05), levonorgestrel (0.25) blister pack with 4 pills & urine PRG test SE: Peripheral edema, N/V/D, bloating, abd pain, fatigue, HA, & menstrual changes; see Ethinyl Estradiol Additional Interactions: ↑ Effects OF ASA, benzodiazepines, metoprolol, TCAs NIPE: Monitor for vision changes or ↓ tolerance of contact lens; will not induce abortion; may ↑ risk of ectopic PRG Ethinyl Estradiol/Levonorgestrel (Seasonale) [Estrogen & Progestin Supplement] WARNING: Cigarette smoking & use of estrogen-based OCPs have ↑ risk of serious cardiovascular side effects; risk ↑ w/ age (esp>35 y) and smoking >15 cig/d Uses: Oral contraceptive Action: Suppresses ovulation by imitating the feedback inhibition of endogenous estrogen and progesterone on the pituitary and hypothalamus Dose: 1 tab PO OD for 91 d; repeat. Use Sunday start for 1st cycle Caution: [X, –]; Contra: Pts w/ DVT, PE, CVD, CAD, estrogen-dependent neoplasms, abnormal uterine bleeding, PRG, hepatic impair Disp: Tabs levonorgestrel 0.15 mg and ethinyl estradiol 30 μg; 91-d pack has 84 active tabs & 7 inert tabs SE: HTN, N, V, HA, breakthrough bleeding, amenorrhea, mastodynia, ↑ risk of gallbladder Dz & thromboembolic disorders Interactions: ↓ Effects W/ barbiturates, carbamazepine, griseofulvin, modafinil, phenobarbital, phenytoin, pioglitazone, rifabutin, ri- ↑ ↓ fampin, ritonavir, topiramate, St John’s wort Labs: Uptake OF T3, T4 sex hormone-binding globulin levels NIPE: Sunday start regimen requires additional contraceptive methods during 1st cycle; use barrier contraception if taking 128 Ethinyl Estradiol & Norelgestromin anticonvulsants; may cause vision changes or ↓ contact lens tolerability; N protection against HIV or STDs; N smoke cigarettes Ethinyl Estradiol & Norelgestromin (Ortho Evra [Estrogen & Progestin Hormones] Uses: *Contraceptive patch* Action: Estrogen & progestin Dose: Apply patch to abdomen, buttocks, upper torso (not breasts), or upper outer arm at the beginning of the menstrual cycle; new patch is applied weekly for 3 wk; week 4 is patch-free Caution: [X, M] Contra: PRG, h/o or current DVT/PE, stroke, MI, CVD, CAD; severe HTN; severe HA w/ focal neurologic Sx; breast/endometrial CA; estrogen-dependent neoplasms; hepatic dysfn; jaundice; major surgery w/ prolonged immobilization; heavy smoking if >35 y Disp: 20 cm2 patch (6 mg norelgestromin [active metabolite norgestimate] & 0.75 mg of ethinyl estradiol) SE: Breast discomfort, HA, site Rxns, N, menstrual cramps; thrombosis risks similar to OCP; see Ethinyl Estradiol Additional Labs: ↑ Serum amylase, Na, Ca, protein NIPE: Less effective in women >90 kg; instruct patient that drug does not protect against STD/HIV Ethosuximide (Zarontin) [Anticonvulsant] Uses: *Absence (petit mal) Szs* Action: Anticonvulsant; ↑ Sz threshold Dose: Adults. Initial, 250 mg PO ÷ bid; ↑ by 250 mg/d q4–7d PRN (max 1500 mg/d) usual maint 20–30 mg/kg. Peds 3–6 y. Initial: 15 mg/kg/d PO ÷ bid. Maint: 15–40 mg/kg/d ÷ bid, max 1500 mg/d Caution: [C, +] in renal/hepatic impair Contra: Component sensitivity Disp: Caps 250 mg; syrup 250 mg/5 mL SE: Blood dyscrasias, GI upset, drowsiness, dizziness, irritability Notes: Levels: Trough: Just before next dose; Therapeu- tic: Peak: 40–100 μg/mL; Toxic Trough: >100 μg/mL; 1/2 life: 30–60 h Interactions: ↑ Effects W/ INH, phenobarbital, EtOH; ↑ effects OF CNS depressants, phenytoin; ↓ effects W/ carbamazepine, valproic acid, ginkgo biloba; ↓ effects OF phenobarbital NIPE: Take w/ food, N EtOH Etidronate Disodium (Didronel) [Hormone/Bisphospho- nates] Uses: *↑ Ca2+ of malignancy, Paget Dz, & heterotopic ossification*Ac- tion: ↓ nl & abnormal bone resorption Dose: Paget Dz: 5–10 mg/kg/d PO ÷ doses (for 3–6 mo). ↑ Ca2+: 7.5 mg/kg/d IV inf over 2 h × 3 d, then 20 mg/kg/d PO on last day of inf × 1–3 mo Caution: [B PO (C parenteral), ?] Contra: Overt osteomalacia, SCr >5 mg/dL Disp: Tabs 200, 400 mg; inj 50 mg/mL SE: GI intolerance (↓ by ÷ daily doses); hypophosphatemia, hypomagnesemia, bone pain, abnormal taste, fever, convulsions, nephrotox Interactions: ↓ Effects W/ antacids, foods that contain Ca NIPE: N Take w/ food d/t < drug absorption; take PO on empty stomach 2 h before any meal Etodolac [Antiarthritic/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Osteoarthritis & pain,* RA Action: NSAID Dose: 200–400 mg PO bid–qid (max 1200 mg/d) Caution: [C (D 3rd tri), ?] ↑ bleeding risk w/ ASA, warfarin; ↑ nephrotox w/ cyclosporine; h/o CHF, HTN, renal/ hepatic impair, PUD Contra: Active GI ulcer Disp: Tabs 400, 500 mg; ER tabs 400, 500, 600 mg; caps 200, 300 mg SE: N/V/D, gastritis, abd cramps, dizziness, HA, Exemestane 129 depression, edema, renal impair Interactions: ↑ Risk of bleeding W/ anticoagulants, antiplts; ↑ effects OF Li, MTX, digoxin, cyclosporine; ↓ effects W/ ASA; ↓ effects OF antihypertensives Labs:↑ LFTs, BUN, Cr; ↓ HMG, Hct, plts, WBC, uric acid NIPE: Take w/ food; do not crush tabs Etonogestrel/Ethinyl Estradiol (NuvaRing) [Estrogen & Progestin Hormones] Uses: *Contraceptive* Action: Estrogen & progestin combo Dose: Rule out PRG 1st; insert ring vaginally for 3 wk, remove for 1 wk; insert new ring 7 d after last removed (even if bleeding) at same time of day ring removed. 1st day of menses is day 1, insert before day 5 even if bleeding. Use other contraception for 1st 7 d of starting therapy. See insert if converting from other contraceptive; after delivery or 2nd tri abortion, insert 4 wk postpartum (if not breast-feeding) Caution: [X, ?/–] HTN, gallbladder Dz, ↑ lipids, migraines, sudden HA Contra: PRG, heavy smokers >35 y, DVT, PE, cerebro-/CV Dz, estrogen-dependent neoplasm, undiagnosed abnormal genital bleeding, hepatic tumors, cholestatic jaundice Disp: Intravaginal ring: Ethinyl estradiol 0.015 mg/d & etonogestrel 0.12 mg/d; see Ethinyl Estradiol; if ring removed, rinse w/ cool/ lukewarm H2O (not hot) & reinsert ASAP; if not reinserted w/in 3 h, effectiveness ↓; do not use with diaphragm Etonogestrel subdermal implant (Implanon) [Hormone] Uses: *Contraception* Action: Transforms endometrium from proliferative to se- cretory Dose: 1 implant subdermally q3y Caution: [X, +] exclude pregnancy before implant Contra: PRG, hormonally responsive tumors, Breast CA, AUB, hepatic tumor, active liver Dz, h/o thromboembolic Dz Disp: 68-mg implant SE: Spotting, irregular periods, amenorrhea, dysmenorrhea, HA, tender breasts, N, wt gain, acne, ectopic PRG, PE, ovarian cysts, stroke, ↑ BP NIPE: 99% effective; remove implant and replace; restricted distribution; health care provider must register and train; does not protect against STDs Etoposide [VP-16] (VePesid, Toposar) [Antineoplastic] Uses: *Testicular, non-small-cell lung CA, Hodgkin Dz & NHLs, peds ALL, & allogeneic/autologous BMT in high doses* Action: Topoisomerase II inhibitor Dose: 50 mg/m2/d IV for 3–5 d; 50 mg/m2/d PO for 21 d (PO availability = 50% of IV); 2–6 g/m2 or 25–70 mg/kg in BMT (per protocols); ↓ in renal/hepatic impair Cau- tion: [D, –] Contra: IT administration Disp: Caps 50 mg; inj 20 mg/mL SE: N/V (emesis in 10–30%), ↓ BM, alopecia, ↓ BP w/ rapid IV, anorexia, anemia, leukopenia, ↑ risk secondary leukemias Interactions: ↑ Bleeding W/ ASA, NSAIDs, warfarin; ↑ BM suppression W/ antineoplastics & radiation; ↑ effects OF cisplatin; ↓ effects OF live vaccines Labs: ↑ Uric acid; ↓ HMG, Hct, plts, RBC, WBC NIPE: N EtOH, immunizations, PRG, breast-feeding; use contraception, 2–3 L/d fluids Exemestane (Aromasin) [Antineoplastic] Uses: *Advanced breast CA in postmenopausal women w/ progression after tamoxifen* Action: Irre- versible, steroidal aromatase inhibitor; ↓ estrogens Dose: 25 mg PO daily after a meal Caution: [D, ?/–] Contra: PRG, Component sensitivity Disp: Tabs 25 mg SE: Hot 130 Exenatide flashes, N, fatigue Interactions: ↓ Effects W/ erythromycin, ketoconazole, phenobarbital, rifampin, other drugs that inhibit P4503A4, St John’s wort, black cohosh, dong quai Labs: ↑ Alkaline phosphatase, bilirubin, alk phos NIPE: N PRG, breast-feeding; take pc and same time each day; monitor BP Exenatide (Byetta) [Hypoglycemic/Incretin] Uses: Type 2 DM combined w/ metformin &/or sulfonylurea Action: An incretin mimetic: ↑ insulin release, ↓ glucagon secretion, ↓ gastric emptying, promotes satiety Dose: 5 μg SQ bid w/in 60 min before AM & PM meals; ↑ to 10 μg SQ bid after 1 mo PRN; do not give pc Caution: [C, ?/–] May ↓ absorption of other drugs (take antibiotics/contraceptives 1 h before) Contra: CrCl <30 mL/min Disp: Soln 5, 10 μg/dose in prefilled pen SE: Hypoglycemia, N/V/D, dizziness, HA, dyspepsia, ↓ appetite, jittery NIPE: Consider ↓ sulfonylurea to ↓ risk of hypoglycemia; discard pen 30 d after 1st use Ezetimibe (Zetia) [Antilipemic/Selective Cholesterol Absorp- tion Inhibitor] Uses: *Hypercholesterolemia alone or w/ a HMG-CoA reductase inhibitor* Action: ↓ Cholesterol & phytosterol absorption Dose: Adults & Peds >10 y. 10 mg/d PO Caution: [C, +/–] Bile acid sequestrants ↓ bioavailability Contra: Hepatic impair Disp: Tabs 10 mg SE: HA, D, abd pain, ↑ transaminases w/ HMG-CoA reductase inhibitor Interactions: ↑ Effects W/ cyclosporine; ↓ effects W/ cholestyramine, fenofibrate, gemfibrozil Labs: ↑ LFTs NIPE: If used w/ fibrates ↑ risk of cholethiasis Ezetimibe/Simvastatin (Vytorin) [Antilipemic/HMG-CoA Re- ductase Inhibitor] Uses: *Hypercholesterolemia* Action: ↓ Absorption of cholesterol & phytosterol w/ HMG-CoA-reductase inhibitor Dose: 10/10–10/80 mg/d PO; w/ cyclosporine or danazol: 10/10 mg/d max; w/ amiodarone or verapamil: 10/20 mg/d max; ↓ w/ severe renal insuff Caution: [X, –]; w/ CYP3A4 inhibitors (Table 11), gemfibrozil, niacin >1g/d, danazol, amiodarone, verapamil Contra: PRG/lactation; liver Dz, ↑ LFTs Disp: Tabs (ezetimibe/simvastatin) 10/10, 10/20, 10/40, 10/80 mg SE: HA, GI upset, myalgia, myopathy (muscle pain, weakness, or tenderness w/ CK 10 × ULN, rhabdomyolysis), hepatitis, Infxn Interactions: ↑ Risk of myopathy W/ clarithromycin, erythromycin, itraconazole, ketoconazole Labs: Monitor LFTs NIPE: N PRGor lactation; use adequate contraception; N EtOH Famciclovir (Famvir) [Antiviral/Synthetic Nucleoside] Uses: *Acute herpes zoster (shingles) & genital herpes* Action: ↓ viral DNA synth Dose: Zoster: 500 mg PO q8h ×7 d. Simplex: 125–250 mg PO bid; ↓ w/ renal impair Caution: [B, –] Contra: Component sensitivity Disp: Tabs 125, 250, 500 mg SE: Fatigue, dizziness, HA, pruritus, N/D Interactions: ↑ Effects W/ cimetidine, probenecid, theophylline; ↑ effects OF digoxin NIPE: Not affected by food, therapy most effective if taken w/in 72 h of initial lesion Famotidine (Pepcid, Pepcid AC) [OTC] [Antisecretory/H2- Receptor Antagonist] Uses: *Short-term Tx of duodenal ulcer & benign Fenoprofen 131 gastric ulcer; maint for duodenal ulcer, hypersecretory conditions, GERD, & heart- ↓ burn* Action: H2-Antagonist; gastric acid Dose: Adults. Ulcer: 20 mg IV q12h or 20–40 mg PO qhs × 4–8 wk. Hypersecretion: 20–160 mg PO q6h. GERD: 20 mg PO bid × 6 wk; maint: 20 mg PO hs. Heartburn: 10 mg PO PRN q12h. Peds. 0.5–1 mg/kg/d; ↓ in severe renal insuff Caution: [B, M] Contra: Component sensitivity Disp: Tabs 10, 20, 40 mg; chew tabs 10 mg; susp 40 mg/5 mL; gelatin cap 10 mg, inj 10 mg/2 mL SE: Dizziness, HA, constipation, D, thrombocytopenia Interac- tions: ↑ GI irritation W/ caffeinated foods, EtOH, nicotine Labs: ↑ BUN, Cr, LFTs NIPE: N ASA, EtOH, tobacco, caffeine; take hs; chew tabs contain phenylalanine Felodipine (Plendil) [Antihypertensive/CCB] Uses: *HTN & CHF* Action: CCB Dose: 2.5–10 mg PO daily; swallow whole; ↓ in hepatic impair Caution: [C, ?] ↑ Effect with azole antifungals, erythromycin, grapefruit juice Contra: Component sensitivity Disp: ER tabs 2.5, 5, 10 mg SE: Peripheral edema, flushing, tachycardia, HA, gingival hyperplasia Interactions: ↑ Effects W/ azole antifungals, cimetidine, cyclosporine, ranitidine, propranolol, EtOH, grapefruit juice; ↑ effects OF digoxin, erythromycin; ↓ effects W/ barbiturates, carbamazepine, nafcillin, NSIDS, oxcarbazepine, phenytoin; rifampin; ↓ effects OF theophylline NIPE: N D/C abruptly; follow BP in elderly & w/ hepatic impair Fenofibrate (Tricor, Anatra, Lofibra, Lipofen, Triglide) [An- tilipemic/Fibric Acid Derivative] Uses: *Hypertriglyceridemia, hyper- cholesteremia* Action: ↓ Triglyceride synth Dose: 48–145 mg daily; ↓ in renal impair, take w/ meals Caution: [C, ?] Contra: Hepatic/severe renal insuff, primary biliary cirrhosis, unexplained ↑ LFTs, gallbladder Dz Disp: Caps 50, 100, 150 mg, Cap (micronized): (Lofibra) 67, 134, 200 mg (Antara) 43, 130 mg; Tabs 54, 160 mg SE: GI disturbances, cholecystitis, arthralgia, myalgia, dizziness, ↑ LFTs Interactions: ↑ Effects OF anticoagulants; ↑ risk of rhabdomyolysis & ARF W/ statins; ↑ risk of renal dysfunction W/ immunosuppressants, nephrotoxic agents; ↓ effects W/ bile acid sequestrants Labs: ↑ LFTs, BUN, Cr; ↓ Hgb, Hct, WBCs, uric acid; NIPE: food ↑ drug absorption; EtOH ↑ triglycerides; may take up to 2 mo to modify lipids Fenoldopam (Corlopam) [Antihypertensive/Vasodilator] Uses: *Hypertensive emergency* Action: Rapid vasodilator Dose: Initial 0.03–0.1 μg/kg/min IV inf, titrate q15min by 1.6 μg/kg/min to max 0.05–0.1 μg/kg/min Caution: [B, ?] ↓ BP w/ β-blockers Contra: Allergy to sulfites Disp: Inj 10 mg/mL SE: ↓ BP, edema, facial flushing, N/V/D, atrial flutter/fibrillation, ↑ IOP Interactions: ↑ Effects W/ acetaminophen ↑ hypotension W/ BBs; ↓ effects W/ dopamine antagonists, metoclopramide Labs: ↓ Serum urea nitrogen, Cr, LFTs, LDH, K+ NIPE: Avoid concurrent β-blockers; asthmatics have ↑ risk of sulfite sensitivity Fenoprofen (Nalfon) [Analgesic/NSAID] WARNING: May ↑ risk of cardiovascular events and GI bleeding Uses: *Arthritis & pain* Action: NSAID Dose: 200–600 mg q4–8h, to 3200 mg/d max; w/ food Caution: [B (D 3rd tri), +/–] 132 Fentanyl

CHF, HTN, renal/hepatic impair, h/o PUD Contra: NSAID sensitivity Disp: Caps 200, 300, 600 mg SE: GI disturbance, dizziness, HA, rash, edema, renal impair, hepatitis Interactions: ↑ Effects W/ ASA, anticoagulants; ↑ hyperkalemia W/ K- sparing diuretics; ↑ effects OF anticoagulants, MTX; ↓ effects W/ phenobarbital; ↓ ↑ N effects OF antihypertensives Labs: False free and total T3 levels NIPE: ASA, EtOH, OTC drugs; swallow whole Fentanyl (Sublimaze) [C-II] [Opioid Analgesic] Uses: *Short- acting analgesic* in anesthesia & PCA Action: Narcotic analgesic Dose: Adults. 25–100 μg/kg/dose IV/IM titrated; Anesthesia: 5–15 μg/kg; Pain: 200 μg over 15 min, titrate to effect Peds. 1–2 μg/kg IV/IM q1–4h titrate; ↓ in renal impair Caution: [B, +] Contra: Paralytic ileus ↑ ICP, resp depression, severe renal/hepatic impair Disp: Inj 0.05 mg/mL SE: Sedation, ↓ BP, bradycardia, constipation, N, resp depression, miosis Interactions: ↑ Effects W/ CNS depressants, cimetidine, erythromycin, ketoconazole, phenothiazine, ritonavir, TCAs, EtOH, grapefruit juice; ↑ risks of HTN crisis W/ MAOIs; ↑ risk of CNS & resp depression W/ Protease Inhibitors; ↓ effects W/ buprenorphine, dezocine, nalbuphine, pentazocine Labs: ↑ Serum amylase, lipase; ↓ HMG, Hct, plts, WBCs NIPE: 0.1 mg fentanyl = 10 mg morphine IM Fentanyl Iontophoretic Transdermal System (Ionsys) [Opi- oid Analgesic] WARNING: May only be used for the treatment of hospitalized patients, D/C on discharge; fentanyl may result in potentially life-threatening respiratory depression and death Uses: *Short-term in hospital analgesia* Action: Opioid narcotic, transdermal administration Dose: 40 μg/activation by patient; dose given over 10 min; max over 24 h 3.2 mg (80 doses) Cau- tion: [C, –] Contra: See Fentanyl Disp: Battery-operated self-contained iontophoretic transdermal system, 40 μg/activation, 80 doses SE: See Fentanyl, site Rxn Interactions: ↑ Effects W/ CNS depressants, cimetidine, erythromycin, ketoconazole, phenothiazine, ritonavir, TCAs, EtOH, grapefruit juice; ↑ risks of HTN crisis W/ MAOIs; ↑ risk of CNS & resp depression W/ protease inhibitors; ↓ effects W/ buprenorphine, dezocine, nalbuphine, pentazocine Labs: ↑ Serum amylase, lipase; ↓ HMG, Hct, plts, WBCs NIPE: Choose normal skin site chest or upper outer arm; titrate to comfort, patients must have access to supplemental analgesia; instruct in device use; dispose properly at discharge Fentanyl, Transdermal (Duragesic) [C-II] [Opioid Analgesic] WARNING: Potential for abuse and fatal overdose Uses: *Persistent moderate– severe chronic pain in patients already tolerant to opioids* Action: Narcotic Dose: Apply patch to upper torso q72h; dose based on narcotic requirements in previous 24 h; start 25 μg/h patch q72h; ↓ in renal impair Caution: [B, +] w/ CYP3A4 inhibitors (Table 11) may ↑ fentanyl effect, w/ h/o substance abuse Contra: Not opioid tolerant, short-term pain management, postop pain in outpatient surgery, mild pain, PRN use ↑ ICP, resp depression, severe renal/hepatic impair, peds <2 y Disp: Patches 12.5, 25, 50, 75, 100 μg/h SE: Resp depression (fatal), sedation, ↓ BP, Ferrous Gluconate Complex 133 bradycardia, constipation, N, miosis Interactions: ↑ Effects W/ CNS depressants, cimetidine, erythromycin, ketoconazole, phenothiazine, ritonavir, TCAs, EtOH, grapefruit juice; ↑ risks OF HTN crisis W/ MAOIs; ↑ risk of CNS & resp depression W/ protease inhibitors; ↓ effects W/ buprenorphine, dezocine, nalbuphine, pentazocine Labs: ↑ Serum amylase, lipase; ↓ HMG, Hct, plts, WBCs NIPE: 0.1 mg fentanyl = 10 mg morphine IM; do not cut patch; peak level 24–72 h; ↑ risk of ↑ absorption w/ elevated temperature; cleanse skin only w/ water, N soap, lotions, or EtOH because they may ↑ absorption; N use in children <110 lb Fentanyl, Transmucosal System (Actiq, Fentora) [C-II] [Opioid Analgesic] WARNING: Potential for abuse and fatal overdose; use only in CA patients with chronic pain who are opioid tolerant; buccal formulation ↑ bioavailability over trans mucosal; do not substitute on a μg/μg basis; use w/ strong CYP3A4 inhibitors may ↑ fentanyl levels Uses: *Breakthrough CA pain* Action: Narcotic analgesic, trans mucosal absorption Dose: Start 100 μg buccal (Fentora) ×1, may repeat in 30 min, 4 tabs/dose max; titrate; start 200 μg PO (Actiq) ×1, may repeat ×1 after 30 min; titrate Caution: [B, +] Contra: ↑ ICP, resp depression, severe renal/hepatic impair, management of postop or awake pain Disp: (Actiq) Lozenges on stick 200, 400, 600, 800, 1200, 1600 μg; (Fentora) Buc- cal Tabs 100, 200, 300, 400, 600, 800 μg SE: Sedation, ↓ BP, bradycardia, constipation, N, resp depression, miosis Interactions: ↑ Effects W/ CNS depressants, cimetidine, erythromycin, ketoconazole, phenothiazine, ritonavir, TCAs, EtOH, grapefruit juice; ↑ risks OF HTN crisis W/ MAOIs; ↑ risk of CNS & resp depression W/ protease inhibitors; ↓ effects W/ buprenorphine, dezocine, nalbuphine, pentazocine Labs: ↑ Serum amylase, lipase; ↓ HMG, Hct, plts, WBCs; 0.1 mg fentanyl = 10 mg IM morphine; for use in patients already tolerant to opioid therapy; N use within 14 d of MAOI Ferrous Gluconate (Fergon) [Oral Iron Supplement] Uses: *Iron deficiency anemia* & Fe supl Action: Dietary supl Dose: Adults. 100–200 mg of elem Fe/d ÷ doses. Peds. 4–6 mg/kg/d ÷ doses; on empty stomach (OK w/ meals if GI upset occurs); avoid antacids Caution: [A, ?] Contra: Hemochromato- sis, hemolytic anemia Disp: Tabs 246 mg (2.8 mg elem), 240 mg (27 mg elem), 300 (34 mg Fe), 325 mg (36 mg Fe) SE: GI upset, constipation, dark stools, discoloration of urine, may stain teeth Notes: 12% elem Fe; false + stool guaiac; keep away from children; severe tox in overdose Interactions: ↑ Effects W/ chloramphenicol, citrus fruits or juices, vitamin C; ↓ effects W/ antacids, levodopa, black cohosh, chamomile, feverfew, gossypol, hawthorn, nettle, plantain, St. John’s wort, whole-grain breads, cheese, eggs, milk, coffee, tea, yogurt; ↓ effects OF fluoroquinolones, tetracycline Labs: False + stool guaiac test NIPE: N Antacids, tetracyclines, take Liq form in Liq and through a straw to prevent teeth staining; 12% elem Fe; keep away from children; severe tox in overdose Ferrous Gluconate Complex (Ferrlecit) [Iron Supplement] Uses: *Iron deficiency anemia or supl to erythropoietin therapy* Action: Fe Supl 134 Ferrous Sulfate

Dose: Test dose: 2 mL (25 mg Fe) IV over 1 h, if OK, 125 mg (10 mL) IV over 1 h. Usual cumulative dose 1 g Fe over 8 sessions (until favorable Hct) Caution: [B, ?] Contra: Non-Fe-deficiency anemia; CHF; Fe overload Disp: Inj 12.5 mg/mL Fe SE: ↓ BP, serious allergic Rxns, GI disturbance, inj site Rxn Interactions: ↑ Ef- fects W/ chloramphenicol, citrus fruits or juices, vitamin C; ↓ effects W/ antacids, levodopa, black cohosh, chamomile, feverfew, gossypol, hawthorn, nettle, plantain, St. John’s wort, whole-grain breads, cheese, eggs, milk, coffee, tea, yogurt; ↓ effects OF fluoroquinolones, tetracycline Labs: False + stool guaiac test NIPE: Dose expressed as mg Fe; may infuse during dialysis Ferrous Sulfate (OTC) [Iron Supplement] Uses: *Fe deficiency anemia & Fe supl* Action: Dietary supl Dose: Adults. 100–200 mg elem Fe/d in ÷ doses. Peds. 1–6 mg/kg/d ÷ daily–tid; on empty stomach (OK w/ meals if GI upset occurs); avoid antacids Caution: [A, ?] ↑ Absorption w/ vitamin C; ↓ absorption w/ tetracycline, fluoroquinolones, antacids, H2-blockers, proton pump inhibitors Con- tra: Hemochromatosis, hemolytic anemia Disp: Tabs 187 (60 mg Fe), 200 (65 mg Fe), 324 (65 mg Fe), 325 mg (65 mg Fe); SR caplets & tabs 160 mg (50 mg Fe), 200 mg (65 mg Fe); gtt 75 mg/0.6 mL (15 mg Fe/0.6 mL); elixir 220 mg/5 mL (44 mg Fe/5 mL); syrup 90 mg/5 mL (18 mg Fe/5 mL) SE: GI upset, constipation, dark stools, discolored urine Interactions: ↑ Effects W/ chloramphenicol, citrus fruits or juices, vitamin C; ↓ effects W/ antacids, levodopa, black cohosh, chamomile, feverfew, gossypol, hawthorn, nettle, plantain, St. John’s wort, whole-grain breads, cheese, eggs, milk, coffee, tea, yogurt; ↓ effects OF fluoroquinolones, tetracycline Labs: False + stool guaiac test NIPE: Take w/ meals if GI upset Fexofenadine (Allegra, Allegra-D) [Antihistamine/H1- Receptor Antagonist] Uses: *Allergic rhinitis* Action: Selective antihistamine, antagonizes H1-receptors Dose: Adults & Peds >12 y. 60 mg PO bid or 180 mg/d; ↓ in renal impair Caution: [C, ?] w/ nevirapine Contra: Component sensitivity Disp: Caps 60 mg; tabs 30, 60, 180 mg; Susp 6 mg/mL; Allegra-D (60 mg fexofenadine/120 mg pseudoephedrine) SE: Drowsiness (rare), HA Interactions: ↑ Effects W/ erythromycin, ketoconazole; ↓ absorption & effects W/ antacids, ap- ples, oranges, grapefruit juice NIPE: N EtOH or CNS depressants Filgrastim [G-CSF] (Neupogen) [Hematopoietic/Colony- Stimulating Factor] Uses: *↓ Incidence of Infxn in febrile neutropenic pts; Rx chronic neutropenia* Action: Recombinant G-CSF Dose: Adults & Peds. 5 μg/kg/d SQ or IV single daily dose; D/C when ANC >10,000 Caution: [C, ?] w/ drugs that potentiate release of neutrophils (eg, lithium) Contra: Allergy to E. coli-derived proteins or G-CSF Disp: Inj 300, 600 μg/mL SE: Fever, alopecia, N/V/D, splenomegaly, bone pain, HA, rash Interactions: ↑ Interference W/ cytotoxic drugs; ↑ release of neutrophils W/ Li Labs: Monitor CBC & plts NIPE: Monitor for cardiac events; no benefit w/ ANC >10,000/mm3 Finasteride (Proscar, Propecia) [Androgen Hormone Inhibitor/ Steroid] Uses: *BPH & androgenetic alopecia* Action: ↓ 5α-Reductase Dose: Floxuridine 135

BPH: 5 mg/d PO. Alopecia: 1 mg/d PO; food may ↓ absorption Caution: [X, –] Hepatic impair Contra: Pregnant women should avoid handling pills, teratogen to male fetus Disp: Tabs 1 mg (Propecia), 5 mg (Proscar) SE: ↓ Libido, volume ejaculate, ED, gynecomastia Interactions: ↑ Effects W/ saw palmetto; ↓ effects W/ anticholinergics, adrenergic bronchodilators, theophylline; Labs: ↓ PSA by 50%; reestablish PSA baseline 6 mo (double PSA for “true” reading) NIPE: 3–6 mo for effect on urinary Sxs; continue to maintain new hair, not for use in women Flavoxate (Urispas) [Antispasmodic] Uses: *Relief of Sx of dysuria, urgency, nocturia, suprapubic pain, urinary frequency, incontinence* Action: Antispasmodic Dose: 100–200 mg PO tid–qid Caution: [B, ?] Contra: GI obst, GI hemorrhage, ileus, achalasia, BPH Disp: Tabs 100 mg SE: Drowsiness, blurred vision, xerostomia Interactions: ↑ Effects OF CNS depressants NIPE: ↑ Risk of heat stroke w/ exercise and in hot weather Flecainide (Tambocor) [Antiarrhythmic/Benzamide Anes- thetic] WARNING: ↑ Mortality in patients with ventricular arrhythmias and recent MI; pulmonary effects reported; pro-ventricular effects seen in atrial arrhythmias Uses: Prevent AF/flutter & PSVT, *prevent/suppress life-threatening ventricular arrhythmias* Action: Class 1C antiarrhythmic Dose: Adults. 100 mg PO q12h; ↑ by 50 mg q12h q4d to max 400 mg/d. Peds. 3–6 mg/kg/d in 3 ÷ doses; ↓ w/ renal impair, Caution: [C, +] Monitor w/ hepatic impair, ↑ conc with amiodarone, digoxin, quinidine, ritonavir/amprenavir, BB, verapamil; may worsen arrhythmias Contra: 2nd-/3rd-degree AV block, RBBB w/ bifascicular or trifascicular block, cardiogenic shock, CAD, ritonavir/amprenavir, alkalinizing agents Disp: Tabs 50, 100, 150 mg SE: Dizziness, visual disturbances, dyspnea, palpitations, edema, chest pain, tachycardia, CHF, HA, fatigue, rash, N Notes: Lev- els: Trough: Just before next dose; Therapeutic: 0.2–1 μg/mL; Toxic: >1 μg/mL; 1/2 life: 11–14 h Interactions: ↑ Effects W/ alkalinizing drugs, amiodarone, cimetidine, propranolol, quinidine; ↑ effects OF digoxin; ↑ risk of arrhythmias W/ CCBs, antiarrhythmics, disopyramide; ↓ effects W/ acidifying drugs, tobacco Labs: ↑ Alkaline phosphatase NIPE: Initiate Rx in hospital; dose q8h if pt is intolerant/ uncontrolled at q12h; full effects may take 3–5 d Floxuridine (FUDR) [Pyrimidine Antimetabolite] WARNING: Administration by experienced physician only; patients should be hospitalized for 1st course due to risk for severe Rxn Uses: *GI adenoma, liver, renal cancers*; colon & pancreatic CAs Action: Converted to 5-FU; inhibits thymidylate synthase; ↓ DNA synth (S-phase specific) Dose: 0.1–0.6 mg/kg/d for 1–6 wk (per protocols) usually intra-arterial for liver mets Caution: [D, –] Interaction w/ vaccines Contra: BM suppression, poor nutritional status, potentially serious Infxn Disp: Inj 500 mg SE: ↓ BM, anorexia, abd cramps, N/V/D, mucositis, alopecia, skin rash, & hyperpigmentation; rare neurotox (blurred vision, depression, nystagmus, vertigo, & lethargy); intra-arterial catheter-related problems (ischemia, thrombosis, bleeding, & Infxn) Interactions: ↑ Effects W/ metronidazole Labs: ↑ LFTs, 5-HIAA urine 136 Fluconazole excretion; ↓ plasma albumin NIPE: Need effective birth control; palliative Rx for inoperable/incurable pts; ↑ risk of photosensitivity—use sunscreen Fluconazole (Diflucan) [Antifungal/Synthetic Azole] Uses: *Candidiasis (esophageal, oropharyngeal, urinary tract, vaginal, prophylaxis); cryptococcal meningitis* Action: Antifungal; ↓ cytochrome P-450 sterol demethy- lation. Spectrum: All Candida sp except C. krusei Dose: Adults. 100–400 mg/d PO or IV. Vaginitis: 150 mg PO daily. Crypto: doses up to 800 mg/d reported: 400 mg day 1, then 200 mg × 10–12 wk after CSF (–). Peds. 3–6 mg/kg/d PO or IV; 12 mg/kg/d/systemic Infxn; ↓ in renal impair Caution: [C, –] Contra: None Disp: Tabs 50, 100, 150, 200 mg; susp 10, 40 mg/mL; inj 2 mg/mL SE: HA, rash, GI upset Interactions: ↑ Effects W/ HCTZ, anticoagulants; ↑ effects OF amitriptyline, benzodiazepines, carbamazepine, cyclosporine, hypoglycemics, losartan, methadone, phenytoin, quinidine, tacrolimus, TCAs, theophylline, caffeine, zidovudine; ↓ effects W/ cimetidine, rifampin Labs: ↑ LFTs; ↓ K+ NIPE: PO (preferred) = IV levels Fludarabine Phosphate (Flamp, Fludara) [Antineoplastic] Uses: *Autoimmune hemolytic anemia, CLL, cold agglutinin hemolysis*, low- grade lymphoma, mycosis fungoides Action: ↓ Ribonucleotide reductase; blocks DNA polymerase-induced DNA repair Dose: 18–30 mg/m2/d for 5 d, as a 30-min inf (per protocols) Caution: [D, –] Give cytarabine before fludarabine (↓ its metabolism) Contra: w/ pentostatin, severe Infxns, CrCl <30 mL/min, hemolytic anemia Disp: Inj 50 mg SE: ↓ BM, N/V/D, edema, CHF, fever, chills, fatigue, dyspnea, nonproductive cough, pneumonitis, severe CNS tox rare in leukemia, autoimmune hemolytic anemia Interactions: ↑ Effects W/ other myelosuppressive drugs; ↑ risk of pulmonary effects W/ pentostatin Labs:? ↑ LFT NIPE: May take several weeks for full effect, use barrier contraception Fludrocortisone Acetate (Florinef) [Steroid/Mineralocorti- coid] Uses: *Adrenocortical insuff, Addison Dz, salt-wasting synd* Action: Mineralocorticoid Dose: Adults. 0.1–0.2 mg/d PO. Peds. 0.05–0.1 mg/d PO Cau- tion: [C, ?] Contra: Systemic fungal Infxns; known allergy Disp: Tabs 0.1 mg SE: HTN, edema, CHF, HA, dizziness, convulsions, acne, rash, bruising, hyperglycemia, HPA suppression, cataracts Interactions: ↑ Risk of hypokalemia W/ amphotericin B, thiazide diuretics, loop diuretics; ↓ effects W/ rifampin, barbiturates, hydantoins; ↓ effects OF ASA, INH Labs: ↓ Serum K+ NIPE: Eval for fluid retention; For adrenal insuff, use w/ glucocorticoid; dose changes based on plasma renin activity Flumazenil (Romazicon) [Antidote/Benzodiazepine] Uses: *Reverse sedative effects of benzodiazepines & general anesthesia* Action: Ben- zodiazepine receptor antagonist Dose: Adults. 0.2 mg IV over 15 s; repeat PRN, to 1 mg max (3 mg max in benzodiazepine OD). Peds. 0.01 mg/kg (0.2 mg/dose max) IV over 15 s; repeat 0.005 mg/kg at 1-min intervals to max 1 mg total; ↓ in hepatic impair Caution: [C, ?] Contra: TCA OD; if pts given benzodiazepines to control Fluoxetine 137 life-threatening conditions (ICP/status epilepticus) Disp: Inj 0.1 mg/mL SE: N/V, palpitations, HA, anxiety, nervousness, hot flashes, tremor, blurred vision, dyspnea, hyperventilation, withdrawal synd Interactions: ↑ Risk of Szs and arrhythmias when benzodiazepine action is reduced NIPE: Food given during IV administration will reduce drug serum level; does not reverse narcotic Sx or amnesia; use associated w/ Sz Flunisolide (AeroBid, Aerospan, Nasarel) [Corticosteroid] Uses: *Asthma in pts requiring chronic steroid therapy; relieve seasonal/perennial allergic rhinitis* Action: Topical steroid Dose: Adults. Met-dose inhal: 2 inhal bid (max 8/d). Nasal: 2 sprays/nostril bid (max 8/d). Peds >6 y. Met-dose inhal: 2 inhal bid (max 4/d). Nasal: 1–2 sprays/nostril bid (max 4/d) Caution: [C, ?] w/ adrenal insuff Contra: Status asthmaticus, viral, TB, fungal, bacterial Infxn; Disp: Aero- bid 0.25 mg/Inh; Nasarel 29 μg/spray; Aerospan 80 μg/Inh (CFC-Free) SE: Tachy- cardia, bitter taste, local effects, oral candidiasis NIPE: Shake well before use; not for acute asthma Fluorouracil [5-FU] (Adrucil) [Antineoplastic/Antimetabo- lite] WARNING: Administration by experienced physician only; patients should be hospitalized for 1st course due to risk for severe Rxn Uses: *Colorectal, gastric, pancreatic, breast, basal cell*, head, neck, bladder, CAs Action: Inhibitor of thymidylate synthetase (interferes with DNA synth, S-phase specific) Dose: 370–1000 mg/m2/d for 1–5 d IV push to 24-h cont inf; protracted venous inf of 200–300 mg/m2/d (per protocol); 800 mg/d max Caution: [D, ?] ↑ Tox w/ allopurinol; do not give MRX before 5-FU Contra: Poor nutritional status, depressed BM Fxn, thrombocytopenia, major surgery w/in past mo, G6PD enzyme deficiency, PRG, serious Infxn, bilirubin >5 mg/dL Disp: Inj 50 mg/mL SE: Stomati- tis, esophagopharyngitis, N/V/D, anorexia, ↓ BM, rash/dry skin/photosens, tingling in hands/feet w/ pain (palmar–plantar erythrodysesthesia), phlebitis/discoloration at inj sites Interactions: ↑ Effects W/ leucovorin Ca Labs: ↑ LFTs NIPE: ↑ Thiamine intake; N EtOH, ↑ risk of photosensitivity—use sunscreen, ↑ fluids 2–3 L/d, use barrier contraception Fluorouracil, Topical [5-FU] (Efudex) [Antineoplastic/An- timetabolite] Uses: *Basal cell carcinoma; actinic/solar keratosis* Action: Inhibits thymidylate synthetase (↓ DNA synth, S-phase specific) Dose: 5% cream bid × 2–6 wk Caution: [D, ?] Irritant chemo Contra: Component sensitivity Disp: Cream 0.5, 1, 5%; soln 1, 2, 5% SE: Rash, dry skin, photosens; see Fluorouracil Additional NIPE: Healing may not be evident for 1–2 mo; N use occlusive dressing; wash hands immediately after; do not overuse application Fluoxetine (Prozac, Sarafem) [Antidepressant/SSRI] WARN- ING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression, OCD, panic disorder, bulimia (Prozac) PMDD (Sarafem)* Action: SSRI Dose: 20 mg/d PO (max 80 mg/d ÷ dose); weekly 90 mg/wk after 1–2 wk of standard dose. Bulimia: 60 mg q AM. Panic disorder: 20 mg/d. 138 Fluoxymesterone

OCD: 20–80 mg/d. PMDD: 20 mg/d or 20 mg intermittently, start 14 d prior to menses, repeat with each cycle; ↓ in hepatic failure Caution: [B, ?/–] Serotonin synd with MAOI, SSRI, serotonin agonists, linezolid; QT prolongation w/ phenothiazine Contra: MAOI/thioridazine (wait 5 wk after D/C before MAOI) Disp: Prozac: Caps 10, 20, 40 mg; scored tabs 10 mg; SR cap 90 mg; soln 20 mg/5 mL. Sarafem: Caps 10, 20 mg SE: N, nervousness, wt loss, HA, insomnia Interac- tions: ↑ Effects W/ CNS depressants, MAOIs, EtOH, St. John’s wort; ↑ effects OF alprazolam, BBs, carbamazepine, clozapine, cardiac glycosides, diazepam, dextromethorphan, loop diuretics, haloperidol, phenytoin, Li, ritonavir, thioridazine, tryptophan, warfarin, sympathomimetic drugs; ↓ effects W/ cyproheptadine; ↓ effects OF buspirone, statins Labs: ↑ LFTs, BUN, Cr, urine albumin; NIPE: ↑ risk of serotonin synd W/ St. John’s wort; may take >4 wk for full effects; Fluoxymesterone (Halotestin, Androxy) [Hormone] Uses: An- drogen-responsive met *breast CA, hypogonadism* Action: ↓ Secretion of LH & FSH (feedback inhibition) Dose: Breast CA: 10–40 mg/d ÷ × 1–3 mo. Hypogo- nadism: 5–20 mg/d Caution: [X, ?/–] ↑ effect w/ anticoagulants, cyclosporine, insulin, lithium, narcotics Contra: Serious cardiac, liver, or kidney Dz; PRG Disp: Tabs 2, 5, 10 mg SE: Priapism, edema, virilization, amenorrhea & menstrual irregularities, hirsutism, alopecia, acne, N, cholestasis; suppression of factors II, V, VII, & X & polycythemia; ↑ libido, HA, anxiety Interactions: ↑ Effects W/ narcotics, EtOH, echinacea; ↑ effects OF anticoagulants, cyclosporine, insulin, hypoglycemics, tacrolimus; ↓ effects W/ anticholinergics, barbiturates Labs: ↑ Cr, CrCl; ↓ thyroxine-binding globulin, serum total T4 NIPE: Radiographic studies of skeletal maturation (hand/wrist) q6mo in prepubertal children; monitor fluid retention Fluphenazine (Prolixin, Permitil) [Antipsychotic/Phenoth- iazine] Uses: *Schizophrenia* Action: Phenothiazine antipsychotic; blocks postsynaptic mesolimbic dopaminergic brain receptors Dose: 0.5–10 mg/d in % doses PO q6–8h, average maint 5 mg/d; or 1.25 mg IM, then 2.5–10 mg/d in % doses q6–8h PRN; ↓ in elderly Caution: [C, ?/–] Contra: Severe CNS depression, coma, subcortical brain damage, blood dyscrasias, hepatic Dz, w/ caffeine, tannic acid, or pectin-containing products Disp: Tabs 1, 2.5, 5, 10 mg; elixir 2.5 mg/5 mL; inj 2.5 mg/mL; depot inj 25 mg/mL SE: Drowsiness, extrapyramidal effects Interactions: ↑ Effects W/ antimalarials, BBs, CNS depressants, EtOH, kava kava; ↑ effects OF anticholinergics, BBs, nitrates; ↓ effects W/ antacids, caffeine, tobacco; ↓ effects OF anticonvulsants, guanethidine, levodopa, sympathomimetics Labs: ↑ LFTs, ↓ HMG, Hct, plts, WBC NIPE: Photosensitivity—use sunscreen; urine may turn pink or red, ↑ risk of heatstroke in hot weather; less sedative/ hypotensive than chlorpromazine Flurazepam (Dalmane) [C-IV] [Sedative/Hypnotic/Benzodi- azepine] Uses: *Insomnia* Action: Benzodiazepine Dose: Adults & Peds >15 y. 15–30 mg PO qhs PRN; ↓ in elderly Caution: [X, ?/–] Elderly, low albumin, hepatic impair Contra: NAG; PRG Disp: Caps 15, 30 mg SE: “Hangover” due to Fluticasone, Oral 139 accumulation of metabolites, apnea, anaphylaxis, angioedema, amnesia Interac- tions: ↑ CNS depression W/ antidepressants, antihistamines, opioids, EtOH; ↑ effects OF digoxin, phenytoin; ↑ effects W/ cimetidine, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, OCPs, propranolol, SSRIs, valproic acid, chamomile, kava, passion flower, valerian; ↓ effects OF levodopa; ↓ effects W/ barbiturates, rifampin, theophylline, nicotine Labs: ↑ LFTs NIPE: N In PRG or lactation; use adequate contraception; N EtOH; N D/C abruptly with long-term use; may cause dependency Flurbiprofen (Ansaid, Ocufen) [Analgesic/NSAID] WARN- ING: May ↑ risk of cardiovascular events and GI bleeding Uses: *Arthritis, ocular surgery* Action: NSAID Dose: 50–300 mg/d ÷ bid–qid, max 300 mg/d w/ food, ocular 1 gtt q30min × 4, beginning 2 h preop Caution: [B (D in 3rd tri), +] Con- tra: PRG (3rd tri); ASA allergy Disp: Tabs 50, 100 mg SE: Dizziness, GI upset, peptic ulcer Dz, ocular irritation Interactions: ↑ Effects W/ amprenavir, anticonvulsants, azole antifungals, BBs, CNS depressants, cimetidine, ciprofloxin, clozapine, digoxin, disulfiram, diltiazem, INH, levodopa, macrolides, OCPs, rifampin, ritonavir, SSRIs, valproic acid, verapamil, EtOH, grapefruit juice, kava kava, valerian; ↓ effects W/ aminophylline, carbamazepine, rifampin, rifabutin, theophylline; ↓ effects OF levodopa Labs: ↑ LFTs NIPE: N PRG, breast-feeding; take with food to ↓ GI upset Flutamide (Eulexin) [Antineoplastic/Antiandrogen] WARN- ING: Liver failure & death reported. Measure LFT before, monthly, & periodically after; D/C immediately if ALT 2 × upper limits of nl or jaundice develops Uses: Advanced *PCa* (w/ LHRH agonists, eg, leuprolide or goserelin); w/ radiation & GnRH for localized CAP Action: Nonsteroidal antiandrogen Dose: 250 mg PO tid (750 mg total) Caution: [D, ?] Contra: Severe hepatic impair Disp: Caps 125 mg SE: Hot flashes, loss of libido, impotence, N/V/D, gynecomastia, hepatic failure Interactions: ↑ Effects W/ anticoagulants Labs: ↑ LFTs (monitor) NIPE: N EtOH; urine amber/yellow-green in color Fluticasone, Nasal (Flonase) [Anti-inflammatory/Corticos- teroid] Uses: *Seasonal allergic rhinitis* Action: Topical steroid Dose: Adults & Peds >12 y: 2 sprays/nostril/d. Peds 4–11 y: 1–2 sprays/nostril/d Caution: [C, M] Contra: Primary Rx of status asthmaticus Disp: Nasal spray 50 μg/actuation SE: HA, dysphonia, oral candidiasis Interactions: ↑ Effects W/ ketoconazole Labs: ↑ glucose NIPE: Clear nares of exudate before use Fluticasone, Oral (Flovent, Flovent Rotadisk) [Anti-inflammatory/Corticosteroid] Uses: Chronic *asthma* Action: Topical steroid Dose: Adults & Adolescents. 2–4 puffs bid. Peds 4–11 y. 50 μg bid Cau- tion: [C, M] Contra: Primary Rx of status asthmaticus Disp: Rotadisk dry powder: 50, 100, 250 μg/activation SE: HA, dysphonia, oral candidiasis Interactions: ↑ Effects W/ ketoconazole Labs: ↑ Cholesterol NIPE: Risk of thrush, rinse mouth after use; counsel on use of device; N & report exposure to measles & chickenpox 140 Fluticasone Propionate & Salmeterol Xinafoate

Fluticasone Propionate & Salmeterol Xinafoate (Advair Diskus, Advair HFA, 45/21, 115/21, 230/21 Inhaled Aerosol) [Anti-inflammatory/Corticosteroid] WARNING: In- β creased risk of worsening wheezing or asthma-related death with long acting 2- adrenergic agonists Uses: *Maint therapy for asthma* Action: Corticosteroid w/ β LA bronchodilator 2-agonist Dose: Adults & Peds >12 y. 1 inhal bid q12h; titrate to lowest effective dose (4 inhal or 920/84 μg/d max) Caution: [C, M] Contra: Acute asthma attack; conversion from PO steroids; w/ phenothiazines Disp: Diskus = met-dose inhal powder (fluticasone/salmeterol in μg) 100/50, 250/50, 500/50; HFA = aerosol 45/21, 115/21, 230/21 mg SE: Upper resp Infxn, pharyngitis, HA Interactions: ↑ Bronchospasm W/ BBs; ↑ hypokalemia W/ loop and thiazide diuretics; ↑ effects W/ ketoconazole, MAOIs, TCAs Labs: ↑ Cholesterol NIPE: Combo of Flovent & Serevent; do not wash mouthpiece, do not exhale into device; ADVAIR HFA for patients not controlled on other medications (eg, low- medium dose inhal steroids) or whose disease severity warrants 2 maint therapies; N & report exposure to measles & chickenpox, rinse mouth after use Fluvastatin (Lescol) [Antilipemic/HMG-CoA Reductase In- hibitor] Uses: *Atherosclerosis, primary hypercholesterolemia, heterozygous familial hypercholesterolemia hypertriglyceridemia* Action: HMG-CoA reductase inhibitor Dose: 20–40 mg bid PO or XL 80 d ↓ w/ hepatic impair Caution: [X, –] Contra: Active liver Dz, ↑ LFTs, PRG, breast-feeding Disp: Caps 20, 40 mg; XL 80 mg SE: HA, dyspepsia, N/D, abd pain Interactions: ↑ Effects W/ azole antifungals, cimetidine, danazol, glyburide, macrolides, phenytoin, ritonavir, EtOH, grapefruit juice; ↑ effects OF diclofenac, glyburide, phenytoin, warfarin; ↓ effects W/ cholestyramine, colestipol, isradipine, rifampin Labs: ↑ LFTs, (monitor) NIPE: Dose no longer limited to hs; ↑ photosensitivity—use sunscreen Fluvoxamine (Luvox) [Antidepressant/SSRI] WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *OCD* Action: SSRI Dose: Initial 50-mg single qhs dose, ↑ to 300 mg/d in ÷ doses; ↓ in elderly/hepatic impair, titrate slowly; ÷ doses >100 mg Caution: [C, ?/-] Interactions (MAOIs, phenothiazines, SSRIs, serotonin agonists, others) Con- tra: MAOI w/in 14 d Disp: Tabs 25, 50, 100 mg SE: HA, N/D, somnolence, insomnia Interactions: ↑ Effects W/ melatonin, MAOIs; ↑ effects OF BBs, benzodiazepines, methadone, carbamazepine, haloperidol, Li, phenytoin, TCAs, theophylline, warfarin, St. John’s wort; ↑ risks of serotonin synd W/ buspirone, dexfenfluramine, fenfluramine, tramadol, nefazodone, sibutramine, tryptophan; ↓ effects W/ buspirone, cyproheptadine, tobacco; ↓ effects OF buspirone, HMG-CoA reductase inhibitors NIPE: N MAOIs for 14 d before start of drug; N EtOH Folic Acid [Vitamin Supplement] Uses: *Megaloblastic anemia; folate deficiency* Action: Dietary supl Dose: Adults. Supl: 0.4 mg/d PO. PRG: 0.8 mg/d PO. Folate deficiency: 1 mg PO daily–tid. Peds. Supl: 0.04–0.4 mg/24 h PO, IM, IV, or SQ. Folate deficiency: 0.5–1 mg/24 h PO, IM, IV, or SQ Caution: [A, +] Fosamprenavir 141

Contra: Pernicious, aplastic, normocytic anemias Disp: Tabs 0.4, 0.8, 1 mg; inj 5 mg/mL SE: Well tolerated Interactions: ↓ Effects W/ anticonvulsants, sulfasalazine, aminosalicyclic acid, chloramphenicol, MTX, OCPs, pyrimethamine, triamterene, trimethoprim; ↓ effects OF phenobarbital, phenytoin NIPE: OK for all women of child-bearing age; ↓ fetal neural tube defects by 50%; no effect on normocytic anemias Fondaparinux (Arixtra) [Anticoagulant/Factor X Inhibitor] WARNING: When epidural/spinal anesthesia or spinal puncture is used, pts anticoagulated or scheduled to be anticoagulated with LMW heparins, heparinoids, or fondaparinux are at risk for epidural or spinal hematoma, which can result in long- term or permanent paralysis Uses: *DVT prophylaxis* w/ hip fracture or replacement, knee replacement, abd surgery; w/ DVT or PE in combo w/ warfarin Action: Synthetic inhibitor of activated factor X; a LMW heparin Dose: 2.5 mg SQ daily, up to 5–9 d; start at least 6 h postop Caution: [B, ?] ↑ Bleeding risk w/ anticoagulants, antiplts, drotrecogin alfa, NSAIDs Contra: Wt <50 kg, CrCl <30 mL/min, active bleeding, SBE, ↓ plt w/ antiplt Ab Disp: Prefilled syringes w/ 27 gauze needle: 2.5 /0.5, 5/0.4, 7.5 /0.6, 10/0.8, mg/mL SE: Thrombocytopenia, anemia, fever, N Interactions: ↑ Effects W/ anticoagulants, cephalosporins, NSAIDs, penicillins, salicylates Labs: ↑ LFTs; ↓ HMG, Hct, plts NIPE: D/C if plts <100,000 mm3; only give SQ; may monitor antifactor Xa levels Formoterol (Foradil Aerolizer) [Bronchodilator/Beta2- Adrenergic Agonist] WARNING: Increased risk of worsening wheezing β or asthma-related death with long-acting 2-adrenergic agonists Uses: Maint Rx of *asthma & prevent bronchospasm* w/ reversible obst airway Dz; exercise-induced β bronchospasm Action: LA 2-adrenergic agonist, bronchodilator Dose: Adults & Peds >5y. Asthma: Inhale one 12-μg cap q12h w/ aerolizer, 24 μg/d max. Adults & Peds > 12y. Exercise-induced bronchospasm: 1 inhal 12-μg cap 15 min before exercise Caution: [C, ?] Contra: Acute asthma, phenothiazines Disp: 12-μg powder for inhal (as caps) for use in Aerolizer SE: Paradoxical bronchospasm, URI, pharyngitis, back pain; Interactions: ↑ Effects W/ adrenergics; ↑ effects OF BBs; ↑ risk of hypokalemia W/ corticosteroids, diuretics, xanthines; ↑ risk of arrhythmias W/ MAOIs, TCAs Labs: ↑ Glucose; ↓ K+ NIPE: Do not swallow caps; only use w/ inhaler; do not start w/ worsening or acutely deteriorating asthma Fosamprenavir (Lexiva) [Antiretroviral/Protease Inhibitor] WARNING: Do not use with severe liver dysfunction, reduce dose with mild–moderate liver impair (fosamprenavir 700 mg bid w/o ritonavir) Uses: HIV Infxn Action: Protease inhibitor Dose: 1400 mg bid w/o ritonavir; w/ ritonavir, fosamprenavir 1400 mg + ritonavir 200 mg daily or fosamprenavir 700 mg + ritonavir 100 mg bid; w/ efavirenz & ritonavir: fosamprenavir 1400 mg + ritonavir 300 mg daily Caution: [C, ?/–]; Contra: w/ ergot alkaloids, midazolam, triazolam, or pimozide; sulfa allergy Disp: Tabs 700 mg SE: N/V/D, HA, fatigue, rash Interac- tions: ↑ Effects W/ indinavir, nelfinavir; ↑ effects OF antiarrhythmics, amitriptyline, 142 Foscarnet atorvastatin, benzodiazepine, bepridil, CCBs, cyclosporine, ergotamine, ethinyl estradiol, imipramine, itraconazole, ketoconazole, midazolam, norethindrone, rapamycin, rifabutin, sildenafil, tacrolimus, TCA, vardenafil, warfarin; ↓ effects W/ antacids, carbamazepine, dexamethasone, didanosine, efavirenz, H2-receptor antagonists, nevirapine, phenobarbital, phenytoin, proton pump inhibitors, rifampin St. John’s wort; ↓ effects OF methadone Labs: ↑ LFTs; triglycerides, lipase; ↓ neutrophils NIPE: Take w/o regard to food; use barrier contraception; monitor for opportunistic Infxn; inform about fat redistribution/accumulation Foscarnet (Foscavir) [Antiviral] Uses: *CMV retinitis*; acyclovir-resistant *herpes Infxns* Action: ↓ Viral DNA polymerase & RT Dose: CMV retinitis: Induction: 60 mg/kg IV q8h or 100 mg/kg q12h × 14–21 d. Maint: 90–120 mg/kg/d IV (Monday–Friday). Acyclovir-resistant HSV: Induction: 40 mg/kg IV q8–12h × 14–21 d; use central line; ↓ with renal impair Caution: [C, –] ↑ Sz potential w/ fluoroquinolones; avoid nephrotoxic Rx (cyclosporine, aminoglycosides, ampho B, protease inhibitors) Contra: CrCl <0.4 mL/min/kg Disp: Inj 24 mg/mL SE: Nephrotox, electrolyte abnormalities Interactions: ↑ Risks of Sz W/ quinolones; ↑ risks of nephrotox W/ aminoglycosides, amphotericin B, didanosine, pentamidine, vancomycin Labs: ↑ LFTs, BUN, SCr; ↓ HMG, Hct, Ca2+, Mg2+, K+, P; monitor ionized Ca2+ NIPE: ↑ Fluids; perioral tingling, extremity numbness & paresthesia indicates electrolyte imbalance; Na loading (500 mL 0.9% NaCl) before & after helps minimize nephrotox Fosfomycin (Monurol) [Antibiotic] Uses: *Uncomplicated UTI* Action: ↓ cell wall synth. Spectrum: Gram(+) (staphylococci, pneumococci); gram(–) (E. coli, Enterococcus sp, Salmonella sp, Shigella sp, H. influenzae, Neis- seria, indole-negative Proteus sp, Providencia sp); B. fragilis & anaerobic gram(–) ↓ cocci are resistant Dose: 3 g PO in 90–120 mL of H2O single dose; in renal impair Caution: [B, ?] ↓ absorption w/ antacids/Ca salts Contra: Component sensitivity Disp: Granule packets 3 g SE: HA, GI upset Interactions: ↓ Effects W/ antacids, metoclopramide Labs: ↑ LFTs; ↓ HMG, Hct NIPE: May take w/o regard to food; may take 2–3 d for Sxs to improve Fosinopril (Monopril) [Antihypertensive/ACEI] Uses: *HTN, CHF*, DN Action: ACE inhibitor Dose: 10 mg/d PO initial; max 40 mg/d PO; ↓ in elderly; ↓ in renal impair Caution: [D, +] ↑ K+ w/ K+ supls, ARBs, K+- sparing diuretics; ↑ renal AE w/ NSAIDs, diuretics, hypovolemia Contra: Hereditary/ idiopathic angioedema or angioedema w/ ACE inhibitor, bilateral RAS Disp: Tabs 10, 20, 40 mg SE: Cough, dizziness, angioedema, ↑ K+ Interactions: ↑ Effects W/ antihypertensives, diuretics; ↑ effects OF Li; ↑ risk of hyperkalemia W/K- sparing diuretics, salt substitutes; ↑ cough W/ capsaicin; ↓ effects W/ antacids, ASA, NSAIDs Labs: ↑ LFTs, K+; ↓ HMG, Hct NIPE: N PRG, breast-feeding Fosphenytoin (Cerebyx) [Anticonvulsant/Hydantoin] Uses: *Status epilepticus* Action: ↓ Sz spread in motor cortex Dose: As phenytoin Furosemide 143 equivalents (PE). Load: 15–20 mg PE/kg. Maint: 4–6 mg PE/kg/d; ↓ dosage, monitor levels in hepatic impair Caution: [D, +] May ↑ phenobarbital Contra: Sinus bradycardia, SA block, 2nd-/3rd-degree AV block, Adams–Stokes synd, rash during Rx Disp: Inj 75 mg/mL SE: ↓ BP, dizziness, ataxia, pruritus, nystagmus Inter- actions: ↑ Effects W/ amiodarone, chloramphenicol, cimetidine, diazepam, disulfiram, estrogens, INH, omeprazole, phenothiazine, salicylates, sulfonamides, tolbutamide; ↓ effects W/ TCAs, antituberculosis drugs, carbamazepine, EtOH, nutritional supls, ginkgo biloba; ↓ effects OF anticoagulants, corticosteroids, digitoxin, doxycycline, OCPs, folic acid, Ca, vitamin D, rifampin, quinidine, theophylline Labs: ↑ Serum glucose, alkaline phosphatase; ↓ serum thyroxine, Ca NIPE: Breast-feeding, for short-term use; 15 min to convert fosphenytoin to phenytoin; admin <150 mg PE/min to prevent ↓ BP; administer with BP monitoring Frovatriptan (Frova) [Migraine Suppressant/5-HT Agonist] Uses: *Rx acute migraine* Action: Vascular serotonin receptor agonist Dose: 2.5 mg PO repeat in 2 h PRN, 7.5 mg/d max PO dose; max 7.5 mg/d Caution: [C, ?/–] Contra: Angina, ischemic heart Dz, coronary artery vasospasm, hemiplegic or basilar migraine, uncontrolled HTN, ergot use, MAOI use w/in 14 d Supplied: Tabs 2.5 mg SE: N, V, dizziness, hot flashes, paresthesias, dyspepsia, dry mouth, hot/cold sensation, chest pain, skeletal pain, flushing, weakness, numbness, coronary vasospasm, HTN Interactions: ↑ Vasoactive reaction W/ ergot drugs; sero- ↑ ↑ tonin 5-HT1 agonists; effects W/ hormonal contraceptives, propranolol; risk of serotonin synd W/ SSRIs NIPE: Risk of photosensitivity Fulvestrant (Faslodex) [Antineoplastic/Antiestrogen] Uses: *HR(+) met breast CA in postmenopausal women w/ progression following antiestrogen therapy* Action: Estrogen receptor antagonist Dose: 250 mg IM monthly, as single 5-mL inj or two concurrent 2.5-mL IM inj in buttocks Caution: [X, ?/–] ↑ Effects w/ CYP3A4 inhibitors (Table 11); w/ hepatic impair Contra: PRG Disp: Prefilled syringes 50 mg/mL (single 5 mL, dual 2.5 mL) SE: N/V/D, constipation, abd pain, HA, back pain, hot flushes, pharyngitis, inj site Rxns Interactions: ↑ Risk of bleeding W/ anticoagulants NIPE: N PRG, breast-feeding; use barrier contraception; only use IM Furosemide (Lasix) [Antihypertensive/Loop Diuretic] Uses: *CHF, HTN, edema*, ascites Action: Loop diuretic; ↓ Na & Cl reabsorption in ascending loop of Henle & distal tubule Dose: Adults 20–80 mg PO or IV bid. Peds. 1 mg/kg/dose IV q6–12h; 2 mg/kg/dose PO q12–24h (max 6 mg/kg/dose) Cau- tion: [C, +] ↓ K+, ↑ risk of digoxin tox; ↑ risk of ototox w/ aminoglycosides, cisplatin (esp in renal dysfunction) Contra: Allergy to sulfonylureas; anuria; hepatic coma; electrolyte depletion Disp: Tabs 20, 40, 80 mg; soln 10 mg/mL, 40 mg/ 5 mL; inj 10 mg/mL SE: ↓ BP, hyperglycemia, ↓ K+ Interactions: ↑ Nephrotoxic effects W/ cephalosporins; ↑ ototox W/ aminoglycosides, cisplatin; ↑ risk of hypokalemia W/ antihypertensives, carbenoxolone, corticosteroids, digitalis glycosides, 144 Gabapentin terbutaline; ↓ effects W/ barbiturates, cholestyramine, colestipol, NSAIDs, phenytoin, dandelion, ginseng; ↓ effects OF hypoglycemics Labs: ↑ BUN, Cr; cholesterol, glucose, uric acid, ↓ serum K+, Na+, Ca2+, Mg2+, monitor electrolytes, renal fxn; NIPE: Risk of photosensitivity—use sunscreen; high doses IV may cause ototox Gabapentin (Neurontin) [Anticonvulsant] Uses: Adjunct in *partial Szs; postherpetic neuralgia (PHN)*; chronic pain synds Action: Anticonvul- sant Dose: Anticonvulsant: 300–1200 mg PO tid (max 3600 mg/d). PHN: 300 mg day 1, 300 mg bid day 2, 300 mg tid day 3, titrate (1800–3600 mg/d); ↓ in renal impair Caution: [C, ?] Contra: Component sensitivity Disp: Caps 100, 300, 400, soln 250 mg/5 mL; tab 600, 800 mg SE: Somnolence, dizziness, ataxia, fatigue Notes: Not necessary to monitor levels Interactions: ↑ Effects W/ CNS depressants; ↓ effects W/ antacids, ginkgo biloba Labs: ↓ WBCs NIPE: Take w/o regard to food Galantamine (Razadyne) [Cholinesterase Inhibitor] Uses: *Alzheimer Dz* Action: Acetylcholinesterase inhibitor Dose: 4 mg PO bid, ↑ to 8 mg bid after 4 wk; may ↑ to 12 mg bid in 4 wk Caution: [B, ?] ↑ Effect w/ succinylcholine, amiodarone, diltiazem, verapamil, NSAIDs, digoxin; ↓ effect w/ anticholinergics, ↑ risk of death vs placebo Contra: Severe renal/hepatic impair Disp: Tabs 4, 8, 12 mg; soln 4 mg/mL SE: GI disturbances, wt loss, sleep disturbances, dizziness, HA Interactions: ↑ Effects W/ amitriptyline, cimetidine, erythromycin, fluoxetine, fluvoxamine, ketoconazole, paroxetine, quinidine Labs: ↓ HMG, Hct; NIPE: ↑ Dosage q4wk, if D/C several days then restart at lowest dose; take w/ food and maintain adequate fluid intake; Caution w/ urinary outflow obst, Parkin- son Dz, severe asthma/COPD, severe heart Dz or ↓ BP Gallium Nitrate (Ganite) [Hormone] Uses: *↑ Ca2+ of malignancy*; bladder CA Action: ↓ bone resorption of Ca2+ Dose: ↑ Ca2+ 200 mg/m2/d × 5 d. CA: 350 mg/m2 cont inf × 5 d to 700 mg/m2 rapid IV inf q2wk in antineoplastic settings (per protocols) Caution: [C, ?] Do not give w/ live or rotavirus vaccine Contra: SCr >2.5 mg/dL Disp: Inj 25 mg/mL SE: Renal insuff, ↓ Ca2+, hypophosphatemia, ↓ bicarb, <1% acute optic neuritis Interactions: ↑ Risks of nephrotox W/ amphotericin B, aminoglycosides, vancomycin NIPE: Monitor SCr, adequate fluids; bladder CA, use in combo w/ vinblastine & ifosfamide Ganciclovir (Cytovene, Vitrasert) [Antiviral/Synthetic Nu- cleoside] Uses: *Rx & prevent CMV retinitis, prevent CMV Dz* in transplant recipients Action: ↓ Viral DNA synth Dose: Adults & Peds. IV: 5 mg/kg IV q12h for 14–21 d, then maint 5 mg/kg/d IV × 7 d/wk or 6 mg/kg/d IV × 5 d/wk. Ocular implant: One implant q5–8mo. Adults. PO: Following induction, 1000 mg PO tid. Prevention: 1000 mg PO tid; with food; ↓ in renal impair Caution: [C, –] ↑ Effect w/ immunosuppressives, imipenem/cilastatin, zidovudine, didanosine, other nephrotoxic Rx Contra: ANC <500, plt <25,000, intravitreal implant Disp: Caps 250, 500 mg; inj 500 mg, ocular implant 4.5 mg SE: Granulocytopenia & Gemifloxacin 145 thrombocytopenia, fever, rash, GI upset Interactions: ↑ Effects W/ cytotoxic drugs, immunosuppressive drugs, probenecid; ↑ risks of nephrotox W/ amphotericin B, cyclosporine; ↑ effects W/ didanosine Labs: ↑ LFTs; ↓ blood glucose NIPE: Take w/ food; N PRG, breast-feeding, EtOH, NSAIDs; photosensitivity—use sunscreen; not a cure for CMV; handle inj w/ cytotox cautions; no systemic benefit w/implant Gefitinib (Iressa) [Antineoplastic] Uses: *Rx locally advanced or met NSCLC after platinum-based & docetaxel chemo fails* Action: ↓ Phosphory- lation of tyrosine kinases; inhibits intracellular domain of EGFR Dose: 250 mg/d PO Caution: [D, –] Disp: Tabs 250 mg SE: D, rash, acne, dry skin, N/V, interstitial lung Dz, ↑ transaminases Interactions: ↑ Effects W/ ketoconazole, itraconazole, and other CYP3A4 inhibitors; ↑ risk of bleeding W/ warfarin; ↓ effects W/ cimetidine, ranitidine and other H2 receptor antagonists, phenytoin, rifampin, and other CYP3A4 inducers Labs: ↑ LFTs (monitor) NIPE: N PRG or breast-feeding; take w/o regard to food; ↑ risk of corneal erosion/ulcer; only give to patients who have already received drug—no new patients because it has not been shown to increase survival Gemcitabine (Gemzar) [Antineoplastic/Nucleoside Analog] Uses: *Pancreatic CA, brain mets, NSCLC*, gastric CA Action: Antimetabolite; ↓ ribonucleotide reductase; produces false nucleotide base-inhibiting DNA synth Dose: 1000 mg/m2 over 30 min–1 h IV inf/wk × 3–4 wk or 6–8 wk; modify dose based on hematologic Fxn (per protocol) Caution: [D, ?/–] Contra: PRG Disp: Inj 200 mg, 1 g SE: ↓ BM, N/V/D, drug fever, skin rash Interactions: ↑ BM depression W/ radiation therapy, antineoplastic drugs; ↓ live virus vaccines Labs: ↑ LFTs, BUN, SCr (monitor) NIPE: N EtOH, NSAIDs, immunizations, PRG; Re- constituted soln 38 mg/mL Gemfibrozil (Lopid) [Antilipemic/Fibric Acid Derivative] Uses: *Hypertriglyceridemia, coronary heart Dz* Action: Fibric acid Dose: 1200 mg/d PO ÷ bid 30 min ac AM & PM Caution: [C, ?] ↑ warfarin effect, sulfonylureas; ↑ risk of myopathy w/ HMG-CoA reductase inhibitors; ↓ effects w/ cyclosporine Contra: Renal/hepatic impair (SCr >2.0 mg/dL), gallbladder Dz, primary biliary cirrhosis Disp: Tabs 600 mg SE: Cholelithiasis, GI upset Interac- tions: ↑ Effects OF anticoagulants, sulfonylureas; ↑ risk of rhabdomyolysis W/ HMG-CoA reductase inhibitors; ↓ effects W/ rifampin; ↓ effects OF cyclosporine Labs: ↑ LFTs, ↓ HMG, Hct, WBCs; LFTs & serum lipids; NIPE: Avoid w/ HMG-CoA reductase inhibitor Gemifloxacin (Factive) [Antibiotic/Fluoroquinolone] Uses: *CAP, acute exacerbation of chronic bronchitis* Action: ↓ DNA gyrase & topoisomerase IV; Spectrum: S. pneumoniae (including MDR strains), H. influenzae, H. parainfluenzae, M. catarrhalis, M. pneumoniae, C. pneumoniae, K. pneumoniae Dose: 320 mg PO daily; CrCl <40 mL/min: 160 mg PO daily Caution: [C, ?/–]; children <18 y; h/o of ↑ QTc interval, electrolyte disorders, w/ Class IA/III antiarrhythmics, erythromycin, TCAs, antipsychotics, ↑ INR and bleed risk w/ warfarin 146 Gemtuzumab Ozogamicin

Contra: Fluoroquinolone allergy Disp: Tab 320 mg SE: Rash, N/V/D, abd pain, dizziness, xerostomia, arthralgia, allergy/anaphylactic Rxns, peripheral neuropathy, tendon rupture Interactions: ↑ Risk of prolonged QT interval W/ amiodarone, antipsychotics, erythromycin, procainamide, quinidine, sotalol, TCAs; ↑ effect OF warfarin; ↑ effects W/ probenecid; ↓ effects W/ antacids, didanosine, iron, sucal- frate Labs: ↑ LFTs NIPE: ↑ Fluid intake; D/C if c/o tenderness/pain in muscles/tendons; N excessive sunlight exposure—use sunscreen; take 3 h before or 2 h after Al/Mg antacids, Fe, Z, or other metal meds Gemtuzumab Ozogamicin (Mylotarg) [Chemotherapeutic Agent/Monoclonal Antibody] WARNING: Can cause severe allergic Rxns & other inf-related Rxns including severe pulm events; hepatotox, including severe hepatic venoocclusive Dz (VOD) reported Uses: *Relapsed CD33+ AML in pts >60 who are poor candidates for chemo* Action: MoAb linked to calicheam- icin; selective for myeloid cells Dose: Per protocol Caution: [D,?/–] Contra: Component sensitivity Disp: 5 mg/20 mL vial SE: ↓ BM, allergy, anaphylaxis, chills, fever, N/V, HA, pulm events, hepatotox Interactions: ↑ Risk for allergic or hypersensitive reaction and thrombocytopenia W/ abciximab; ↓ effects W/ abciximab Labs: Monitor before & after therapy CBC, ALT, AST, electrolytes NIPE: Monitor for bleeding, myelosuppression, BP; N ASA, PRG, breast-feeding; single- agent use only, not in combo; premedicate w/ diphenhydramine & acetaminophen Gentamicin (Garamycin, G-Mycitin, others) [Antibiotic/Amino- glycoside] Uses: *Serious Infxns* due to Pseudomonas, Proteus, E. coli, Kleb- siella, Enterobacter, & Serratia & initial Rx gram(–) sepsis Action: Bactericidal; ↓ protein synth Spectrum: gram(–) (not Neisseria, Legionella, Acinetobacter); synergy w/ PCNs Dose: Adults. 3–7 mg/kg/24h IV ÷ q8–24h. Synergy: 1 mg/kg q8h Peds. In- fants <7 d <1200 g: 2.5 mg/kg/dose q18–24h. Infants >1200 g: 2.5 mg/kg/dose q12–18h. Infants >7 d: 2.5 mg/kg/dose IV q8–12h. Children: 2.5 mg/kg/d IV q8h; ↓ w/ renal insuff Caution: [C, +/–] Avoid other nephrotoxics Contra: Aminoglycoside sensitivity Disp: Premixed infus 40, 60, 70, 80, 90, 100, 120 mg; ADD-Vantage inj vials 10 mg/mL; inj 40 mg/mL; IT preservative-free 2 mg/mL SE: Nephro/oto/neurotoxicity Notes: Levels: Peak: 30 min after inf; Trough < 0.5 h before next dose; Thera- peutic: Peak 5–8 mcg/ml, Trough < 2 mcg/mL; Toxic Peak > 12 mcg/mL; 1/2 life: 2h; Interactions: ↑ Ototoxicity, neurotoxicity, nephrotoxicity W/ aminoglycosides, amphotericin B, cephalosporins, loop diuretics, penicillins; ↑ effects W/ NSAIDs; ↓ effects W/ carbenicillin; Labs: ↑ LFTs, BUN, crea; ↓ hmg, hct, platelets, WBC; NIPE: Photosensitivity—use sunscreen; Follow CrCl, SCr & serum conc for dose adjustments; daily dosing popular; use IBW to dose (use adjusted if obese > 30% IBW); Gentamicin & Prednisolone, Ophthalmic (Pred-G Ophthalmic) [Antibiotic/Anti-inflammatory] Uses: *Steroid-responsive ocular & conjunctival Infxns* sensitive to gentamicin Action: Bactericidal; ↓ protein synth w/ anti-inflammatory. Spectrum: Staphylococcus sp, E. coli, H. influenzae, Klebsiella Glipizide 147 sp, Neisseria sp, Pseudomonas sp, Proteus sp, & Serratia sp Dose: Oint: 1/2 in. in conjunctival sac daily–tid. Susp: 1 gtt bid–qid, up to 1 gtt/h for severe Infxns Con- tra: Aminoglycoside sensitivity Caution: [C, ?] Disp: Oint, ophth: Prednisolone acetate 0.6% & gentamicin sulfate 0.3% (3.5 g). Susp, ophth: Prednisolone acetate 1% & gentamicin sulfate 0.3% (2, 5, 10 mL) SE: Local irritation; see Gentamicin Additional NIPE: Systemic effects W/ long-term use Gentamicin, Ophthalmic (Garamycin, Genoptic, Gentacidin, Gentak, others) [Antibiotic] Uses: *Conjunctival Infxns* Action: Bac- tericidal; ↓ protein synth Dose: Oint: Apply 1/2 in. bid–tid. Soln: 1–2 gtt q2–4h, up to 2 gtt/h for severe Infxn Caution: [C, ?] Contra: Aminoglycoside sensitivity Disp: Soln & oint 0.1% and 0.3% SE: Local irritation; see Gentamicin NIPE: N Other eye drops for 10 min after administering this drug; do not touch dropper to eye Gentamicin, Topical (Garamycin, G-Mycitin) [Antibiotic] Uses: *Skin Infxns* caused by susceptible organisms Action: Bactericidal; ↓ protein synth Dose: Adults & Peds >1 y. Apply tid–qid Caution: [C, ?] Contra: Aminoglycoside sensitivity Disp: Cream & oint 0.1% SE: Irritation; see Gentam- icin NIPE: N Apply to large denuded areas Glimepiride (Amaryl) [Hypoglycemic/Sulfonylurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output/production Dose: 1–4 mg/d, max 8 mg Caution: [C, –] Contra: DKA Disp: Tabs 1, 2, 4 mg SE: HA, N, hypoglycemia Interactions: ↑ Effects W/ ACEIs, adrenergic antagonists, BBs, chloramphenicol, MAOIs, NSAIDs, probenecid, salicylates, sulfonamides, warfarin, ginseng, garlic; ↓ effects W/ corticosteroids, estrogens, INH, OCPs, nicotinic acid, phenytoin, sympathomimetics, thiazide diuretics, thyroid hormones Labs: ↑ LFTs, BUN, Cr; ↓ HMG, Hct, plts, WBC, RBC, glucose NIPE: Antabuse-like effect w/ EtOH; Give w/ 1st meal of day Glimepiride/pioglitazone (Duetact) [Hypoglycemic/Sul- fonylurea/Thiazolidinedione] Uses: *Adjunct to exercise type 2 DM not controlled by single agent* Action: Sulfonylurea (↓ glucose) w/ agent that ↑ insulin sens & ↓ gluconeogenesis Dose: initial 30 mg/2 mg PO qAM; 45 mg pioglitazone/8 mg glimepiride/d max; w/ food Caution: [C, ?/–] w/ liver impair, elderly Contra: Component hypersensitivity, DKA Disp: Tabs 30/2, 30 mg/4 mg SE: Hct, ↑ ALT, ↓ glucose, URI, ↑ wt, edema, HA, N/D, may ↑ CV mortality Interactions: ↑ Effects W/ ACEIs, adrenergic antagonists, BBs, chloramphenicol, MAOIs, NSAIDs, probenecid, salicylates, sulfonamides, warfarin, ginseng, garlic; ↓ effects W/ corticosteroids, estrogens, INH, OCPs, nicotinic acid, phenytoin, sympathomimetics, thiazide diuretics, thyroid hormones Labs: ↑ LFTs, BUN, Cr; ↓ HMG, Hct, plts, WBC, RBC, glucose; monitor CBC, ALT, Cr NIPE: Monitor wt Glipizide (Glucotrol, Glucotrol XL) [Hypoglycemic/Sulfony- lurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; 148 Glucagon

↑ peripheral insulin sensitivity; ↓ hepatic glucose output/production; ↓ intestinal glucose absorption Dose: 5 mg initial, ↑ by 2.5–5 mg/d, max 40 mg/d; XL max 20 mg; 30 min ac; hold if NPO Caution: [C, ?/–] Severe liver Dz Contra: DKA, Type 1 DM, sulfonamide sensitivity Disp: Tabs 5, 10 mg; XR tabs 2.5, 5, 10 mg SE: HA, anorexia, N/V/D, constipation, fullness, rash, urticaria, photosens Interactions: ↑ Effects W/ azole antifungals, anabolic steroids, chloramphenicol, cimetidine, clofibrate, MAOIs, NSAIDs, probenecid, salicylates, sulfonamides, TCAs, warfarin, celery, coriander, dandelion root, fenugreek, ginseng, garlic, juniper berries; ↓ effects W/ amphetamines, corticosteroids, epinephrine, estrogens, glucocorticoids, OCPs, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid hormones, tobacco LABS: ↑ BUN, Cr, AST, lipids; ↓ glucose, HMG, WBC, plts NIPE: Antabuse-like effect w/ EtOH; give 30 min before meal; hold dose if pt NPO; counsel about DM management; wait several days before adjusting dose; monitor glucose Glucagon [Antihypoglycemic/Hormone] Uses: Severe *hypoglycemic* Rxns in DM with sufficient liver glycogen stores; β-blocker OD Ac- tion: Accelerates liver gluconeogenesis Dose: Adults. 0.5–1 mg SQ, IM, or IV; repeat in 20 min PRN. β-blocker OD: 3–10 mg IV; repeat in 10 min PRN; may give cont inf 1–5 mg/h (ECC 2005). Peds. Neonates: 0.3 mg/kg/dose SQ, IM, or IV q4h PRN. Children: 0.025–0.1 mg/kg/dose SQ, IM, or IV; repeat in 20 min PRN Cau- tion: [B, M] Contra: Pheochromocytoma Disp: Inj 1 mg SE: N/V, ↓ BP Interac- tions: ↑ Effect W/ epinephrine, phenytoin; ↑ effects OF anticoagulants Labs: ↓ Serum K+ NIPE: Response w/in 20 min after inj; administration of glucose IV necessary; ineffective in starvation, adrenal insuff, or chronic hypoglycemia Glyburide (DiaBeta, Micronase, Glynase) [Hypoglycemic/ Sulfonylurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output/production; ↓ intestinal glucose absorption Dose: 1.25–10 mg daily–bid, max 20 mg/d. Micronized: 0.75–6 mg daily–bid, max 12 mg/d Caution: [C, ?] Renal impair Contra: DKA, Type I DM Disp: Tabs 1.25, 2.5, 5 mg; micronized tabs 1.5, 3, 6 mg SE: HA, hypoglycemia Interactions: ↑ Effects W/ anticoagulants, anabolic steroids, BBs, chloramphenicol, cimetidine, clofibrate, MAOIs, NSAIDs, probenecid, salicylates, sulfonamides, TCAs, EtOH, celery, coriander, dandelion root, fenugreek, ginseng, garlic, juniper berries; ↓ effects W/ amphetamines, corticosteroids, baclofen, epinephrine, glucocorticoids, OCPs, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid hormones, tobacco Labs:↑ LFTs, BUN; ↓ glucose, HMG, Hct, plts, WBC NIPE: Antabuse-like effect w/ EtOH; not OK for CrCl <50 mL/min; hold dose if NPO Glyburide/Metformin (Glucovance) [Hypoglycemic/Sul- fonylurea & Biguanide] Uses: *Type 2 DM* Action: Sulfonylurea: ↑ Pancreatic insulin release. Metformin: Peripheral insulin sensitivity; ↓ hepatic glucose output/production; ↓ intestinal glucose absorption Dose: 1st line (naive pts), 1.25/250 mg PO daily–bid; 2nd line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg); Granisetron 149 take w/ meals, slowly ↑ dose; hold before & 48 h after ionic contrast media Cau- tion: [C, –] Contra: SCr >1.4 in females or >1.5 in males; hypoxemic conditions (sepsis, recent MI); alcoholism; metabolic acidosis; liver Dz Disp: Tabs 1.25/250 mg, 2.5/500 mg, 5/500 mg SE: HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Notes: See Glyburide Additional Interactions: ↑ Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin; ↓ effects W/ CCBs, INH, phenothiazines Labs: Monitor folate levels (megaloblastic anemia) NIPE: Avoid EtOH; hold dose if NPO Glycerin Suppository [Laxative] Uses: *Constipation* Action: Hy- perosmolar laxative Dose: Adults. 1 adult supp PR PRN. Peds. 1 infant supp PR daily–bid PRN Caution: [C, ?] Disp: Supp (adult, infant); Liq 4 mL/applicatorful SE: D Interactions: ↑ Effects W/ diuretics Labs: ↑ Serum triglycerides, phos- phatidylglycerol in amniotic fluid; ↓ serum Ca NIPE: Insert and retain for 15 min Gonadorelin (Lutrepulse) [Gonadotropin-Releasing Hor- mone] Uses: *Primary hypothalamic amenorrhea* Action: Stimulates pituitary release of LH & FSH Dose: 5 μg IV q90min × 21 d using pump kit Caution: [B, M] ↑ Levels w/ androgens, estrogens, progestins, glucocorticoids, spironolactone, levodopa; ↓ levels with OCP, digoxin, dopamine antagonists Contra: Condi- tion exacerbated by PRG or reproductive hormones, ovarian cysts, causes of anovulation other than hypothalamic, hormonally dependent tumor Disp: Inj 100 μg SE: Multiple PRG risk Interactions: ↑ Effects W/ androgens, estrogens, glucocorticoids, levodopa, progestins, spironolactone; ↓ effects W/ digoxin, dopamine antagonists, OCPs, phenothiazines Labs: Monitor LH, FSH NIPE: Inj site pain Goserelin (Zoladex) [Antineoplastic/Gonadotropin-Releas- ing Hormone] Uses: Advanced *CA Prostate* & w/ radiation for localized high-risk Dz, *endometriosis, breast CA* Action: LHRH agonist, transient ↑ then ↓ in LH, w/ ↓ testosterone Dose: 3.6 mg SQ (implant) q28d or 10.8 mg SQ q3mo; usually lower abd wall Caution: [X, –] Contra: PRG, breast-feeding, 10.8-mg implant not for women Disp: SQ implant 3.6 (1 mo), 10.8 mg (3 mo) SE: Hot flashes, ↓ libido, gynecomastia, & transient exacerbation of CA-related bone pain (“flare Rxn” 7–10 d after 1st dose) Interactions: None noted Labs: ↑ LFTs, cholesterol, triglycerides; initial ↑ then ↓ after 1–2 wk FSH, LH, testosterone NIPE: Inj SQ into fat in abd wall; do not aspirate; females must use contraception Granisetron (Kytril) [Antiemetic/5-HT3 Antagonist] Uses: *Prevention of N/V* Action: Serotonin receptor antagonist Dose: Adults & Peds. 10 μg/kg/dose IV 30 min prior to chemo Adults. Inj 0.1, 1 mg/mL 2 mg PO 1 h prior to chemo, then 12 h later. Postop N/V: 1 mg IV before end of OR case Caution: [B, +/–] St. John’s wort ↓ levels Contra: Liver Dz, children <2 y Disp: Tabs 1 mg; inj 0.1, 1 mg/mL; soln 2 mg/10 mL SE: HA, constipation Interactions: ↑ Serotoner- gic effects W/ horehound; ↑ extrapyramidal Rxns W/ drugs causing these effects Labs: ↑ ALT, AST; ↓ HMG, Hct, plts, WBC NIPE: May cause anaphylactic Rxn 150 Guaifenesin

Guaifenesin (Robitussin, Others) [Expectorant/Propanediol Derivative] Uses: *Relief of dry, nonproductive cough* Action: Expecto- rant Dose: Adults. 200–400 mg (10–20 mL) PO q4h SR 600–1200 mg PO BID, (max 2.4 g/d). Peds. <2 y: 12 mg/kg/d in 6 ÷ doses. 2–5 y: 50–100 mg (2.5–5 mL) PO q4h (max 600 mg/d). 6–11 y: 100–200 mg (5–10 mL) PO q4h (max 1.2 g/d) Caution: [C, ?] Disp: Tabs 100, 200; SR tabs 600, 1200 mg; caps 200 mg; SR caps 300 mg; Liq 100 mg/5 mL SE: GI upset Interactions: ↑ Bleeding W/ heparin Labs: ↓ serum uric acid level, HMG, plts, WBCs NIPE: Give w/ large amount of H2O; some dosage forms contain EtOH Guaifenesin & Codeine (Robitussin AC, Brontex, Others) [C-V] [Expectorant/Analgesic/Antitussive] Uses: *Relief of dry cough* Action: Antitussive w/ expectorant Dose: Adults. 5–10 mL or 1 tab PO q6–8h (max 60 mL/24 h). Peds. 2–6 y: 1–1.5 mg/kg codeine/d ÷ dose q4–6h (max 30 mg/24 h). 6–12 y: 5 mL q4h (max 30 mL/24 h) Caution: [C, +] Disp: Brontex tab 10 mg codeine/300 mg guaifenesin; Liq 2.5 mg codeine/75 mg guaifenesin/5 mL; others 10 mg codeine/100 mg guaifenesin/5 mL SE: Somnolence Interactions: ↑ CNS depression W/ barbiturates, antihistamines, glutethimide, methocarbamol, cimetidine, EtOH; ↓ effects W/ quinidine Labs: ↑ Urine morphine; ↓ serum uric acid level, HMG, plts, WBCs NIPE: Take w/ food Guaifenesin & Dextromethorphan (Many OTC Brands) [Expectorant/Antitussive] Uses: *Cough* due to upper resp tract irritation Action: Antitussive w/ expectorant Dose: Adults & Peds >12 y. 10 mL PO q6–8h (max 40 mL/24 h). Peds. 2–6 y: Dextromethorphan 1–2 mg/kg/24 h ÷ 3–4 × d (max 10 mL/d). 6–12 y: 5 mL q6–8h (max 20 mL/d) Caution: [C, +] Contra: Administration w/ MAOI Disp: Many OTC formulations SE: Somnolence Inter- actions: ↑ Effects W/ quinidine, terbinafine; ↑ effects OF isocarboxazid, MAOIs, phenelzine; ↑ risk of serotonin synd W/ sibutramine Labs: ↓ Serum uric acid level, HMG, plts, WBCs NIPE: Give with plenty of fluids Haemophilus B Conjugate Vaccine (ActHIB, HibTITER, Ped- vaxHIB, Prohibit, Others) [Vaccine/Inactivated] Uses: Rou- tine *immunization* of children against H. influenzae type B Dzs Action: Active immunization against Haemophilus type B Dose: Peds. 0.5 mL (25 mg) IM in deltoid or vastus lateralis Caution: [C, +] Contra: Febrile illness, immunosuppression, allergy to thimerosal Disp: Inj 7.5, 10, 15, 25 μg/0.5 mL SE: Observe for anaphylaxis; edema, ↑ risk of Haemophilus type B Infxn the week after vaccination Interactions: ↓ Effects W/ immunosuppressives, steroids NIPE: Booster not required; report SAE to VAERS: 1-800-822-7967 Haloperidol (Haldol) [Antipsychotic/Butyrophenone] Uses: *Psychotic disorders, agitation, Tourette disorders, hyperactivity in children*Ac- tion: Antipsychotic, neuroleptic Dose: Adults. Moderate Sxs: 0.5–2 mg PO bid–tid. Severe Sxs/agitation: 3–5 mg PO bid–tid or 1–5 mg IM q4h PRN (max 100 mg/d). Hepatitis A Vaccine 151

Peds. 3–6 y: 0.01–0.03 mg/kg/24 h PO daily. 6–12 y: Initial, 0.5–1.5 mg/24 h PO; ↑ by 0.5 mg/24 h to maint of 2–4 mg/24 h (0.05–0.1 mg/kg/24 h) or 1–3 mg/dose IM q4–8h to 0.1 mg/kg/24 h max; Tourette Dz may require up to 15 mg/24 h PO; ↓ in elderly Caution: [C, ?] ↑ Effects w/ SSRIs, CNS depressants, TCA, indomethacin, metoclopramide; avoid levodopa (↓ antiparkinsonian effects) Contra: NAG, severe CNS depression, coma, Parkinson Dz, BM suppression, severe cardiac/hepatic Dz Disp: Tabs 0.5, 1, 2, 5, 10, 20 mg; conc Liq 2 mg/mL; inj 5 mg/mL; decanoate inj 50, 100 mg/mL SE: Extrapyramidal Sxs (EPS), ↓ BP, anxiety, dystonias Interactions: ↑ Effects W/ CNS depressants, quinidine, EtOH; ↑ hypotension W/ antihypertensives, nitrates; ↑ anticholinergic effects W/ antihistamines, antidepressants, atropine, phenothiazines, quinidine, disopyramide; ↓ effects W/ antacids, carbamazepine, Li, nutmeg, tobacco; ↓ effects OF anticoagulants, levodopa, guanethidine Labs: ↑ LFTs NIPE: ↑ Risk of photosensitivity—use sunscreen; do not give decanoate IV; dilute PO conc Liq w/ H2O/juice; monitor for EPS Heparin [Aticoagulant/Antithrombotic] Uses: *Rx & prevention of DVT & PE*, unstable angina, AF w/ emboli, & acute arterial occlusion Action: Acts w/ antithrombin III to inactivate thrombin & ↓ thromboplastin formation Dose: Adults. Prophylaxis: 3000–5000 units SQ q8–12h. Thrombosis Rx: Load 50–80 units/kg IV, then 10–20 units/kg IV qh (adjust based on PTT); bolus 60 IU/kg (max 4000 IU); then 12 IU/kg/h (max 1000 IU/h for patients >70 kg) round to nearest 50 IU; keep PTT 1.5–2.0 (control 48 h or until angiography (ECC 2005) Peds. Infants: Load 50 units/kg IV bolus, then 20 units/kg/h IV by cont inf. Chil- dren: Load 50 units/kg IV, then 15–25 units/kg cont inf or 100 units/kg/dose q4h IV intermittent bolus (adjust based on PTT) Caution: [B, +] ↑ Risk of hemorrhage w/ anticoagulants, ASA, antiplts, cephalosporins w/ MTT side chain Contra: Un- controlled bleeding, severe thrombocytopenia, suspected ICH Disp: Inj 10, 100, 1000, 2000, 2500, 5000, 7500, 10,000, 20,000, 40,000 units/mL SE: Bruising, bleeding, thrombocytopenia Interactions: ↑ Effects W/ anticoagulants, antihistamines, ASA, clopidogrel, cardiac glycosides, cephalosporins, pyridamole, NSAIDs, quinine, tetracycline, ticlopidine, feverfew, ginkgo biloba, ginger, valerian; ↓ effects W/ nitroglycerine, ginseng, goldenseal, ↓ effects OF insulin Labs: ↑ LFTs; follow PTT, thrombin time, or activated clotting time; little PT effect; therapeutic PTT 1.5–2 × control for most conditions; monitor for HIT w/ plt counts Hepatitis A Vaccine (Havrix, Vaqta) [Vaccine/Inactivated] Uses: *Prevent Hep A* in high-risk individuals (eg, travelers, certain professions, or high- risk behaviors) Action: Active immunity Dose: (Expressed as ELISA units [EL.U.]) Havrix: Adults. 1440 EL.U. single IM dose. Peds >2 y. 720 EL.U. single IM dose. Vaqta: Adults. 50 units single IM dose. Peds. 25 units single IM dose Caution: [C, +] Contra: Component allergy Disp: Inj 720 EL.U./0.5 mL, 1440 EL.U./1 mL; 50 units/mL SE: Fever, fatigue, HA, inj site pain Interactions: None noted NIPE: N if pt febrile; booster OK 6–12 mo after primary; report SAE to VAERS: 1-800-822-7969 152 Hepatitis A

Hepatitis A (Inactivated) & Hepatitis B (Recombinant) Vac- cine (Twinrix) [Vaccine/Inactivated] Uses: *Active immunization against Hep A/B* Action: Active immunity Dose: l mL IM at 0, 1, & 6 mo Caution: [C, +] Contra: Component sensitivity Disp: Single-dose vials, syringes SE: Fever, fatigue, pain at site, HA; Interactions: ↓ Immune response W/ corticosteroids, immunosuppressants NIPE: ↑ Response if inj in deltoid vs gluteus; booster OK 6–12 mo after vaccination; report SAE to VAERS: 1-800-822-7967 Hepatitis B Immune Globulin (HyperHep, H-BIG) [Hepatitis B Prophylaxis/Immunoglobuline] Uses: *Exposure to HBsAg(+) material* (eg, blood, plasma, or serum, accidental needlestick, mucous membrane contact, PO) Action: Passive immunization Dose: Adults & Peds. 0.06 mL/kg IM 5 mL max; w/in 24 h of exposure; w/in 14 d of sexual contact; repeat 1 mo if non- responder or refused initial after exposure Caution: [C, ?] Contra: Allergies to γ- globulin or anti-immunoglobulin Ab; allergies to thimerosal; IgA deficiency Disp: Inj SE: Inj site pain, dizziness Interactions: ↓ Immune response if given W/ live virus vaccines; IM in gluteal or deltoid; w/ continued exposure, give Hep B vaccine Hepatitis B Vaccine (Engerix-B, Recombivax HB) [Vaccine/ Inactivated] Uses: *Prevent Hep B* Action: Active immunization; recombinant DNA Dose: Adults. 3 IM doses 1 mL each; 1st 2 doses 1 mo apart; the 3rd 6 mo after the 1st. Peds. 0.5 mL IM adult schedule Caution: [C, +] ↓ effect w/ immunosuppressives Contra: Yeast allergy Disp: Engerix-B: Inj 20 μg/mL; peds inj 10 μg/0.5 mL. Recombivax HB: Inj 10 & 40 μg/mL; peds inj 5 μg/0.5 mL SE: Fever, inj site pain Interactions: ↓ Immune response W/ corticosteroids, immunosuppressants NIPE: ↑ Response inj in deltoid vs gluteus; deltoid IM inj adults/ older peds; younger peds, use anterolateral thigh Hetastarch (Hespan) [Plasma Volume Expander] Uses: *Plasma volume expansion* adjunct in shock & leukapheresis Action: Synthetic colloid; acts similar to albumin Dose: Volume expansion: 500–1000 mL (1500 mL/d max) IV (20 mL/kg/h max rate). Leukapheresis: 250–700 mL; ↓ in renal failure Caution: [C, +] Contra: Severe bleeding disorders, CHF, oliguric/anuric renal failure Disp: Inj 6 g/100 mL SE: Bleeding (↑ PT, PTT, bleed time) Labs: Monitor CBC, PT, PTT NIPE: Observe for anaphylactic Rxns; not blood or plasma substitute Human Papillomavirus (Types 6,11,16,18) Recombinant Vaccine (Gardasil) [Vaccine] Uses: *Prevent cervical CA, precancer- ous genital lesions, and genital warts due to HPV types 6, 11, 16, 18 in females 9–26 y* Action: Recombinant vaccine, passive humoral immunity Dose: 0.5 mL IM initial, then 2 and 6 mo Caution: [B, ?/–] Disp: Single-dose vial and prefilled syringe: 0.5 mL SE: Site Rxn (pain, erythema, swelling, pruritus), fever Interactions: w/ immunosuppressants, may get decreased response NIPE: Give IM in deltoid or upper thigh; 1st approved CA vaccine; report adverse events to VAERS 1-800-822-7967; register PRG patients exposed to drug (800) 986-8999 Hydrochlorothiazide & Spironolactone 153

Hydralazine (Apresoline, Others) [Antihypertensive/Vasodila- tor] Uses: *Moderate–severe HTN; CHF* (w/ Isordil) Action: Peripheral vasodilator Dose: Adults. Initial 10 mg PO qid, ↑ to 25 mg qid 300 mg/d max. Peds. 0.75–3 mg/kg/24 h PO ÷ q6–12h; ↓ in renal impair; CBC & ANA before Caution: [C, +] ↓ Hepatic Fxn & CAD; ↑ tox w/ MAOI, indomethacin, β-blockers Contra: Dissecting aortic aneurysm, mitral valve/rheumatic heart Dz Disp: Tabs 10, 25, 50, 100 mg; inj 20 mg/mL SE: SLE-like synd w/ chronic high doses; SVT following IM route, peripheral neuropathy Interactions: ↑ Effects W/ antihypertensives, diazoxide, diuretics, MAOIs, nitrates, EtOH; ↓ pressor response W/ epinephrine; ↓ effects W/ NSAIDs; NIPE: Take w/ food; compensatory sinus tachycardia eliminated w/ β-blocker Hydrochlorothiazide (HydroDIURIL, Esidrix, Others) [Anti- hypertensive/Thiazide Diuretic] Uses: *Edema, HTN* Action: Thi- azide diuretic; ↓ distal tubule Na reabsorption Dose: Adults. 25–100 mg/d PO single or ÷ doses. Peds. <6 mo: 2–3 mg/kg/d in 2 ÷ doses. >6 mo: 2 mg/kg/d in 2 ÷ doses Caution: [D, +] Contra: Anuria, sulfonamide allergy, renal insuff Disp: Tabs 25, 50, mg; caps 12.5 mg; PO soln 50 mg/5 mL SE: ↓ K+, hyperglycemia, hyperuricemia, ↓ Na+ Interactions: ↑ Hypotension W/ ACEIs, antihypertensives, carbenoxolone, ↑ hypokalemia W/ carbenoxolone, corticosteroids; ↑ hypergylcemia W/ BBs, diazoxide, hypoglycemic drugs; ↑ effects OF Li, MRX; ↓ effects W/ amphetamines, cholestyramine, colestipol, NSAIDs, quinidine, dandelion Labs: ↑ Glucose, cholesterol, Ca, uric acid levels; ↓ K+, Na+, HMG, Hct, plts, WBCs NIPE: Take w/ food; ↑ risk of photosensitivity—use sunscreen Hydrochlorothiazide & Amiloride (Moduretic) [Antihyper- tensive/Thiazide & K+ Sparing Diuretic] Uses: *HTN* Action: Combined thiazide & K+-sparing diuretic Dose: 1–2 tabs/d PO Caution: [D, ?] Contra: Renal failure, sulfonamide allergy Disp: Tabs (amiloride/HCTZ) 5 mg/50 mg SE: ↓ BP, photosens, ↑ K+/↓ K+, hyperglycemia, ↓ Na+, hyperlipidemia, hyperuricemia Interactions: ↑ Hypotension W/ACEIs, antihypertensives, carbenoxolone, ↑ hypokalemia W/ amphotericin B, carbenoxolone, corticosteroids, licorice; ↑ risk of hyperkalemia W/ ACE-I, K-sparing diuretics, NSAIDs, & K salt substitutes; ↑ hypergylcemia W/ BBs, diazoxide, hypoglycemic drugs; ↑ effects OF amantadine, antihypertensives, digoxin, Li, MTX; ↑ effects W/ CNS depressants; ↓ effects W/ amphetamines, cholestyramine, colestipol, NSAIDs, quinidine, dandelion Labs: ↑ Glucose, cholesterol,Ca, uric acid levels; ↓ Na+, HMG, Hct, plts, WBCs; ↑ K+/↓ K+; interferes W/ glucose tolerance test; monitor electrolytes, LFTs, uric acid NIPE: Take w/ food, I&O, daily wt, N salt substitutes, bananas, & oranges ↑ risk of photosensitivity—use sunscreen Hydrochlorothiazide & Spironolactone (Aldactazide) [Anti- hypertensive/Thiazide & K+ Sparing Diuretic] Uses: *Edema, HTN* Action: Thiazide & K+-sparing diuretic Dose: 25–200 mg each component/d, ÷ doses Caution: [D, +] Contra: Sulfonamide allergy Disp: Tabs (HCTZ/spironolactone) 25 mg/25 mg, 50 mg/50 mg SE: Photosens, ↓ BP, ↑ or ↓ K+, ↓ Na+, hyperglycemia, 154 Hydrochlorothiazide & Triamterene hyperlipidemia, hyperuricemia Additional Interactions ↑ Risk of hyperkalemia W/ ACEIs, K-sparing diuretics, K supls, salt substitutes; ↓ effects OF digoxin NIPE: DC drug 3 d before glucose tolerance test Hydrochlorothiazide & Triamterene (Dyazide, Maxzide) [An- tihypertensive/Thiazide & K+ sparing Diuretic] Uses: *Edema & HTN* Action: Combo thiazide & K+-sparing diuretic Dose: Dyazide: 1–2 caps PO daily–bid. Maxzide: 1 tab/d PO Caution: [D, +/–] Contra: Sulfonamide allergy Disp: (Triamterene/HCTZ) 37.5 mg/25 mg, 75 mg/50 mg SE: Photosens, ↓ BP, ↑ or ↓ K+, ↓ Na+, hyperglycemia, hyperlipidemia, hyperuricemia; See Hy- drochlorothiazide. Additional Interactions: ↑ Risk of hyperkalemia W/ ACEIs, K-sparing diuretics, K supls, salt substitutes; ↑ effects W/ cimetidine, licorice root, ↓ effects OF digoxin Labs: ↑ Serum glucose, BUN, Cr, K+, Mg2+, uric acid, urinary Ca2+; interference W/ assay of quinidine & lactic dehydrogenase NIPE: Urine may turn blue; HCTZ component in Maxzide more bioavailable than in Dyazide Hydrocodone & Acetaminophen (Lorcet, Vicodin, Hycet, Others) [C-III] [Narcotic Analgesic/Antitussive] Uses: *Moder- ate–severe pain*; Action: Narcotic analgesic w/ nonnarcotic analgesic Dose: Adult: 1–2 caps or tabs PO q4–6h PRN; soln 15 mL q4–6h Peds: Soln (Hycet) 0.27 mL/kg q4–6h Caution: [C, M] Contra: CNS depression, severe resp depression Disp: Many formulations; specify hydrocodone/APAP dose; caps 5/500; tabs 2.5/500, 5/325, 5/400, 5/500, 7.5/325, 7.5/400, 7.5/500, 7.5/650, 7.5/750, 10/325, 10/400, 10/500, 10/650, 10/660, 10/750; soln Hycet (fruit punch) (7.5 mg hydrocodone/325 mg acetaminophen /15 mL SE: GI upset, sedation, fatigue; Interactions: ↑ Effects W/ antihistamines, cimetidine, CNS depressants, dextroamphetamines, glutethimide, MAOIs, protease inhibitors, TCAs, EtOH, St. John’s wort; ↑ effects OF warfarin; ↓ effects W/ phenothiazines Labs: False ↑ amylase, lipase NIPE: Take w/ food, ↑ fluid intake; do not exceed >4 g APAP/d Hydrocodone & Aspirin (Lortab ASA, others) [C-III] [Nar- cotic Analgesic] Uses: *Moderate–severe pain* Action: Narcotic analgesic with NSAID Dose: 1–2 PO q4–6h PRN, w/ food/milk Caution: [C, M] ↓ Renal Fxn, gastritis/PUD, Contra: Component sensitivity; children w/ chickenpox (Reye synd) Disp: 5 mg hydrocodone/500 mg ASA/tab SE: GI upset, sedation, fatigue Notes: Monitor for GI bleed; see Hydrocodone and Acetaminophen Hydrocodone & Guaifenesin (Hycotuss Expectorant, others) [C-III] [Narcotic/Expectorant] Uses: *Nonproductive cough* associated with resp Infxn Action: Expectorant w/ cough suppressant Dose: Adults & Peds >12 y. 5 mL q4h pc & hs. Peds. <2 y: 0.3 mg/kg/d ÷ qid. 2–12 y: 2.5 mL q4h pc & hs Caution: [C, M] Contra: Component sensitivity Disp: Hydrocodone 5 mg/guaifenesin 100 mg/5 mL SE: GI upset, sedation, fatigue see Hydrocodone and Acetaminophen Additional Interactions: ↑ Bleeding W/ heparin Hydrocodone & Homatropine (Hycodan, Hydromet, others) [C-III] [Narcotic Analgesic/Antitussive] Uses: *Relief of cough* Hydrocortisone, Topical & Systemic 155

Action: Combo antitussive Dose: (Based on hydrocodone) Adults. 5–10 mg q4–6h. Peds. 0.6 mg/kg/d ÷ tid–qid Caution: [C, M] Contra: NAG, ↑ ICP, depressed ventilation Disp: Syrup 5 mg hydrocodone/5 mL; tabs 5 mg hydrocodone SE: Sedation, fatigue, GI upset; see Hydrocodone and Acetaminophen Additional Labs: ↑ ALT, AST NIPE: Do not give < q4h Hydrocodone & Ibuprofen (Vicoprofen) [C-III] [Narcotic Analgesic/NSAID] Uses: *Moderate–severe pain (<10 d)* Action: Nar- cotic w/ NSAID Dose: 1–2 tabs q4–6h PRN Caution: [C, M] Renal insuff; ↓ effect w/ ACE inhibitors & diuretics; ↑ effect w/ CNS depressants, EtOH, MAOI, ASA, TCA, anticoagulants Contra: Component sensitivity Disp: Tabs 7.5 mg hydrocodone/200 mg ibuprofen, SE: Sedation, fatigue, GI upset; see Hydrocodone and Acetaminophen Additional Interactions: ↓ Effects OF ACEIs, diuretics Hydrocodone & Pseudoephedrine (Detussin, Histussin-D, others) [C-III] [Antitussive/Decongestant] Uses: *Cough & nasal congestion* Action: Narcotic cough suppressant with decongestant Dose: 5 mL qid, PRN Caution: [C, M] Contra: MAOIs Disp: Hydrocodone/pseudoephedrine 5 mg /60 mg, 3 mg/15 mg 5 mL; tab 5 mg/60 mg SE: ↑ BP, GI upset, sedation, fatigue; see Hydrocodone and Acetaminophen Additional Interactions: ↑ Effects W/ sympathomimetics Hydrocodone, Chlorpheniramine, Phenylephrine, Aceta- minophen, & Caffeine (Hycomine Compound) [C-III] [Nar- cotic Analgesic/Antitussive/Antihistamine] Uses: *Cough & Sxs of URI* Action: Narcotic cough suppressant w/ decongestants & analgesic Dose: 1 tab PO q4h PRN Caution: [C, M] Contra: NAG Disp: Hydrocodone 5 mg/chlorpheniramine 2 mg/phenylephrine 10 mg/APAP 250 mg/caffeine 30 mg/tab SE: ↑ BP, GI upset, sedation, fatigue; see Hydrocodone and Acetaminophen Hydrocortisone, Rectal (Anusol-HC Suppository, Cortifoam Rectal, Proctocort, others) [Corticosteroid] Uses: *Painful anorectal conditions*, radiation proctitis, ulcerative colitis Action: Anti-inflammatory steroid Dose: Adults. Ulcerative colitis: 10–100 mg PR daily–bid for 2–3 wk Caution: [B, ?/–] Contra: Component sensitivity Disp: Hydrocortisone acetate: Rectal aerosol 90 mg/applicator; supp 25 mg. Hydrocortisone base: Rectal 0.5%, 1%, 2.5%; rectal susp 100 mg/60 mL SE: Minimal systemic effect NIPE: Admin- ister after BM, insert supp blunt end 1st, admin enema W/ pt lying on side and retain for 1 h Hydrocortisone, Topical & Systemic (Cortef, Solu-Cortef) [Corticosteroid] See Steroids and Tables 3 & 4 Caution: [B, –] Contra: Viral, fungal, or tubercular skin lesions; serious Infxns (except septic shock or TB meningitis) SE: Systemic: ↑ appetite, insomnia, hyperglycemia, bruising Notes: May cause HPA axis suppression Interactions: ↑ Effects W/ cyclosporine, estrogens; ↑ effects OF cardiac glycosides, cyclosporine; ↑ risk of GI bleed W/ NSAIDs; ↓ effects W/ aminoglutethimide, antacids, barbiturates, cholestyramine, 156 Hydromorphone colestipol, ephedrine, phenobarbital, phenytoin, rifampin; ↓ effects OF anticoagulants, hypoglycemics, insulin, INH, salicylates Labs: ↑ Glucose, cholesterol; ↓ K+, Ca+ NIPE: N EtOH, live virus vaccines, abrupt D/C of drug; take w/ food; may mask S/Sxs Infxn Hydromorphone (Dilaudid) [C–II] [Narcotic Analgesic] Uses: *Moderate/severe pain* Action: Narcotic analgesic Dose: 1–4 mg PO, IM, IV, or PR q4–6h PRN; 3 mg PR q6–8h PRN; ↓ w/ hepatic failure Caution: [B (D if prolonged use or high doses near term), ?] ↑ respiratory depression and CNS effects CNS depressants, phenothiazines, TCA Contra: Component sensitivity Disp: Tabs 2, 4 mg, 8 mg; Liq 5 mg/5 mL or 1 mg/mL; inj 1, 2, 4, 10 mg/mL; supp 3 mg SE: Sedation, dizziness, GI upset Interactions: ↑ Effects W/ CNS depressants, phenothiazines, TCAs, EtOH, St. John’s wort; ↓ effects W/ nalbuphine, pentazocine Labs: ↑ Serum amylase, lipase NIPE: Take w/ food; ↑ fluids & fiber to prevent constipation; morphine 10 mg IM = hydromorphone 1.5 mg IM Hydroxocobalamin (Cyanokit) [Antidote] Uses: *Cyanide poisoning* Action: Binds cyanide to form nontoxic cyanocobalamin excreted in urine Dose: 70 mg/kg IV ×1, repeat X1 PRN max 5-g single dose; inf over 7.5 min Cau- tion: [C, ?] Contra: None known Disp: Kit 2 2.5 g vials w/ inf set SE: ↑ BP (can be severe) anaphylaxis, chest tightness, edema, urticaria, rash, chromaturia, N, HA NIPE: Inj site Rxns Hydroxyurea (Hydrea, Droxia) [Antineoplastic/Antimetabo- lite] Uses: *CML, head & neck, ovarian & colon CA, melanoma, ALL, sickle cell anemia, polycythemia vera, HIV* Action: ↓ Ribonucleotide reductase Dose: (per protocol) 50–75 mg/kg for WBC >100,000 cells/mL; 20–30 mg/kg in refractory CML. HIV: 1000–1500 mg/d in single or ÷ doses; ↓ in renal insuff Caution: [D, –] ↑ Effects w/ zidovudine, zalcitabine, didanosine, stavudine, fluorouracil Contra: Severe anemia, BM suppression, WBC <2500 or plt <100,000, PRG Disp: Caps 200, 300, 400, 500 mg, tabs 1000 mg SE: ↓ BM (mostly leukopenia), N/V, rashes, facial erythema, radiation recall Rxns, renal impair Interactions: ↑ Risk of pancreatitis W/ didanosine, indinavir, stavudine; ↑ BM depression W/ antineoplastic drugs or radiation therapy Labs: ↑ Serum uric acid, BUN, Cr NIPE: ↑ Fluids 10–12 glasses/d, use barrier contraception, ↑ risk OF infertility; empty caps into H2O Hydroxyzine (Atarax, Vistaril) [Antipsychotic, Sedative/ Hypnotic/Antihistamine] Uses: *Anxiety, sedation, itching* Action: Antihistamine, antianxiety Dose: Adults. Anxiety/sedation: 50–100 mg PO or IM qid or PRN (max 600 mg/d). Itching: 25–50 mg PO or IM tid–qid. Peds. 0.5–1.0 mg/kg/24 h PO or IM q6h; ↓ w/ hepatic impair Caution: [C, +/–] ↑ Effects w/ CNS depressants, anticholinergics, EtOH Contra: Component sensitivity Disp: Tabs 10, 25, 50 mg; caps 25, 50 mg; syrup 10 mg/5 mL; susp 25 mg/5 mL; inj 25, 50 mg/mL SE: Drowsiness, anticholinergic effects Interactions: ↑ Effects W/ Ibandronate 157 antihistamines, anticholinergics, CNS depressants, EtOH Labs: False—skin allergy tests; false ↑ in urinary 17-hydroxycorticosteroid levels NIPE: Used to potentiate narcotic effects; not for IV/SQ (thrombosis & digital gangrene possible) Hyoscyamine (Anaspaz, Cystospaz, Levsin, others) [Anti- spasmodic/Anticholinergic] Uses: *Spasm w/ GI & bladder disorders* Action: Anticholinergic Dose: Adults. 0.125–0.25 mg (1–2 tabs) SL/PO tid–qid, ac & hs; 1 SR cap q12h Caution: [C, +] ↑ effects w/ amantadine, antihistamines, antimuscarinics, haloperidol, phenothiazines, TCA, MAOI Contra: BOO, GI obst, NAG, MyG, paralytic ileus, ulcerative colitis, MI Disp: (Cystospaz-M, Levsinex): time release caps 0.375 mg; elixir (EtOH); soln 0.125 mg/5 mL; inj 0.5 mg/mL; tab 0.125 mg; tab (Cystospaz) 0.15 mg; XR tab (Levbid): 0.375 mg; SL (Levsin SL) 0.125 mg SE: Dry skin, xerostomia, constipation, anticholinergic SE, heat prostration w/ hot weather Interactions: ↑ Effects W/ amantadine, antimuscarinics, haloperidol, phenothiazines, quinidine, TCAs, MAOIs; ↓ effects W/ antacids, antidiarrheals; ↓ effects OF levodopa NIPE: ↑ Risk of heat intolerance; photophobia; administer tabs before meals/food Hyoscyamine, Atropine, Scopolamine, & Phenobarbital (Donnatal, others)[Antispasmodic Anticholinergic Uses: *Irri- table bowel, spastic colitis, peptic ulcer, spastic bladder* Action: Anticholinergic, antispasmodic Dose: 0.125–0.25 mg (1–2 tabs) tid–qid, 1 cap q12h (SR), 5–10 mL elixir tid–qid or q8h Caution: [D, M] Contra: NAG Disp: Many combos/manu- facturers; Cap (Donnatal, others): Hyosc. 0.1037 mg/atropine 0.0194 mg/scop 0.0065 mg/phenobarbital 16.2 mg. Tabs (Donnatal, others): Hyosc. 0.1037 mg/atropine 0.0194 mg/scop 0.0065 mg/phenobarbital 16.2 mg. LA (Donnatal): Hyosc. 0.311 mg/atropine 0.0582 mg/scop 0.0195 mg/phenobarbital 48.6 mg. Elixirs (Donnatal, others): Hyosc. 0.1037 mg/atropine 0.0194 mg/scop 0.0065 mg/phenobarbital 16.2 mg/5 mL SE: Sedation, xerostomia, constipation Interactions: ↑ Anticholinergic effects W/ amantadine, antihistamines, disopyramide; merperidine, procainamide, quinidine, TCA; ↑ effects OF/ atenolol; ↓ effects W/ antacids NIPE: Take drug without food Ibandronate (Boniva) [Bone Resorption Inhibitor/Bisphos- phonate] Uses: *Rx & prevent osteoporosis in postmenopausal women* Action: Bisphosphonate, ↓ osteoclast-mediated bone-resorption Dose: 2.5 mg PO daily or 150 mg once/mo on same day (do not lie down for 60 min after); 3 mg IV over 15–30 sec q3mo Caution: [C, ?/–] Avoid w/ CrCl <30 mL/min Contra: Un- corrected ↓ Ca2+; inability to stand/sit upright for 60 min (PO) Disp: Tabs 2.5, 150 mg, inj IV 3 mg/3 mL SE: Jaw osteonecrosis (avoid extensive dental procedures) N/D, HA, dizziness, asthenia, HTN, Infxn, dysphagia, esophagitis, esophageal/ gastric ulcer, musculoskeletal pain Interactions: ↑ GI upset W/ ASA, NSAIDs; ↓ absorption W/ antacids, vitamins, supl or other drugs containing Ca+, Mg+, Fe; EtOH, food, milk Labs: ↑ Cholesterol; ↓ alk phos NIPE: ↑ Risk OF 158 Ibuprofen photophobia, constipation, urinary hesitancy; take 1st thing in AM w/ H2O (6–8 oz) >60 min before 1st food/beverage & any meds w/ multivalent cations; give adequate Ca2+ & vitamin D supls Ibuprofen (Motrin, Rufen, Advil, Others) [OTC] [Anti-inflammatory, Antipyretic, Analgesic/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis, pain, fever* Action: NSAID Dose: Adults. 200–800 mg PO bid–qid (max 2.4 g/d). Peds. 30–40 mg/kg/d in 3–4 ÷ doses (max 40 mg/kg/d); w/ food Caution: May interfere w/ ASA’s antiplt effect if given <8 hr before ASA [B, +] Contra: 3rd tri PRG, severe hepatic impair, allergy, use w/ other NSAIDs, UGI bleed, ulcers Disp: Tabs 100, 200, 400, 600, 800 mg; chew tabs 50, 100 mg; caps 200 mg; susp 100 mg/2.5 mL, 100 mg/5 mL, 40 mg/mL (200 mg OTC form) SE: Dizziness, peptic ulcer, plt inhibition, worsening of renal insuff Interactions: ↑ Effects W/ ASA, corticosteroids, probenecid, EtOH; ↑ effects OF aminoglycosides, anticoagulants, digoxin, hypoglycemics, Li, MTX; ↑ risks of bleeding W/ abciximab, cefotetan, valproic acid, thrombolytic drugs, warfarin, ticlopidine, garlic, ginger, ginkgo biloba; ↓ effects W/ feverfew; ↓ effects OF antihypertensives Labs: ↑ BUN, Cr, LFTs; ↓ HMG, Hct, BS, plts, WBCs NIPE: Take w/ food Ibutilide (Corvert) [Antiarrhythmic/Ibutilide Derivative] Uses: *Rapid conversion of AF/flutter* Action: Class III antiarrhythmic Dose: Adults >60 kg 0.01 mg/kg (max 1 mg) IV inf over 10 min; may repeat × 1; <60 kg use 0.01 mg/kg (ECC 2005; D/C cardioversion preferred) Caution: [C, –] Contra: w/ class I/III antiarrhythmics (Table 10); QTc >440 ms Disp: Inj 0.1 mg/mL SE: Arrhythmias, HA Interactions: ↑ Refractory effects W/ amiodarone, disopyramide, procainamide, quinidine, sotalol; ↑ QT interval W/ antihistamines, antidepressants, erythromycin, phenothiazines, TCAs NIPE: Give w/ ECG monitoring Idarubicin (Idamycin) [Antineoplastic/Anthracycline] WARNING: Administer only under supervision of a health care provider experienced in leukemia and in an institution with resources to maintain a patient com- promised by drug tox Uses: *Acute leukemias* (AML, ALL, ANLL), *CML in blast crisis, breast CA* Action: DNA intercalating agent; ↓ DNA topoisomerases I & II Dose: (per protocol) 10–12 mg/m2/d for 3–4 d; ↓ in renal/hepatic impairment Caution: [D, –] Contra: Bilirubin >5 mg/dL, PRG Disp: Inj 1 mg/mL (5, 10, 20 mg vials) SE: ↓ BM, cardiotox, N/V, mucositis, alopecia, & IV site Rxns, rarely ↓ renal/hepatic Fxn Interactions: ↑ Myelosuppression W/ antineoplastic drugs and radiation therapy; ↓ effects OF live virus vaccines Labs: ↑ BUN, Cr, uric acid, LFTs; ↓ HMG, Hct, plts, RBCs, WBCs NIPE: ↑ Fluids to 2–3 L/d; Avoid extrav, potent vesicant; IV only Ifosfamide (Ifex, Holoxan) [Antineoplastic/Alkylating Agent] Uses: Lung, breast, pancreatic & gastric CA, HL/NHL, soft tissue sarcoma Action: Alkylating agent Dose: (per protocol) 1.2 g/m2/d for 5 d bolus or cont inf; 2.4 g/m2/d for 3 d; w/ Mesna uroprotection; ↓ in renal/hepatic impair Caution: Imipenem–Cilastatin 159

[D, M] ↑ Effect w/ phenobarbital, carbamazepine, phenytoin; St. John’s wort may ↓ levels Contra: ↓ BM Fxn, PRG Disp: Inj 1, 3 g SE: Hemorrhagic cystitis, nephrotox, N/V, mild–moderate leukopenia, lethargy & confusion, alopecia, ↑ hepatic enzyme Interactions: ↑ Risk of bleeding W/ anticoagulants, ASA, NSAIDs; ↑ effects W/ barbituates, chloral hydrate, phenytoin; ↑ myelosuppression W/ antineoplastic drugs and radiation therapy; ↓ effects OF live virus vaccines; ↓ effects W/ corticosteroids Labs: ↑ LFTs, uric acid; ↓ plts, WBCs NIPE: ↑ Fluids to 2–3 L/d; administer w/ mesna to prevent hemorrhagic cystitis Iloprost (Ventavis) [Prostaglandin Analog] WARNING: Associ- ated with syncope; may require dosage adjustment Uses: NYHA Class III/IV pulm arterial HTN* Action: Prostaglandin analog Dose: Initial 2.5 μg; if tolerated, ↑ to 5 μg inh 6–9 ×/d (at least 2 h apart) while awake Caution: [C, ?/–] Antiplt effects, ↑ bleeding risk w/ anticoagulants; additive hypotensive effects Contra: SBP <85 mm Hg Disp: Inh soln 10 μg/mL SE: Syncope, ↓ BP, vasodilation, cough, HA, trismus Interactions: ↑ Effects OF anticoagulants, antihypertensives, antiplts Labs: ↑ Alk phos NIPE: Instruct pt of syncope risk; monitor BP; requires Pro- Dose AAD or I-neb ADD system nebulizer; counsel on syncope risk Imatinib (Gleevec) [Antineoplastic/Tyrosin Kinase Inhibitor] Uses: *Rx CML Ph +, CML blast crisis, ALL Ph +, myelodysplastic/myeloprolifera- tive Dz, aggressive systemic mastocytosis, chronic eosinophilic leukemia, GIST, der- matofibrosarcoma protuberans* Action: ↓ BCL-ABL tyrosine kinase (signal transduction) Dose: Adult: Typical dose: 400–600 mg PO daily; w/ meal. Peds: CML Ph + newly diagnosed 340 mg/m2/d, 600 mg/d max; recurrent 260 mg/m2/d PO ÷ daily–bid, to 340 mg/m2/d max Caution: [D, ?/–] w/ CYP3A4 meds (Table 11), warfarin Contra: Component sensitivity Disp: Tab 100, 400 mg SE: GI upset, fluid retention, muscle cramps, musculoskeletal pain, arthralgia, rash, HA, neutropenia, thrombocytopenia Additional Interactions: ↑ Effects OF cyclosporine, CCB, HMG-CoA reductase inhibitiros, triazolobenzodiazepines, erythromycine, itraconazole, ketoconazole; ↑ risk of liver tox W/ acetaminophen; ↓ effects W/ carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John’s wort Labs: ↑ LFTs; ↓ HMG, Hct, neutrophils, plts; follow CBCs & LFTs baseline & monthly NIPE: Take w/ food & ↑ fluids to decrease GI irritation, use barrier contraception Imipenem–Cilastatin (Primaxin) [Antibiotic/Carbapenem] Uses: *Serious Infxns* due to susceptible bacteria Action: Bactericidal; ↓ cell wall synth. Spectrum: Gram(+) (S. aureus, group A & B streptococci), gram(–) (not Legionella sp), anaerobes Dose: Adults. 250–1000 mg (imipenem) IV q6–8h, 500–750 mg IM 1/2 h. Peds. 60–100 mg/kg/24 h IV ÷ q6h; ↓ if CrCl is <70 mL/min Caution: [C, +/–] Probenecid ↑ tox Contra: Ped pts w/ CNS Infxn (↑ Sz risk) & <30 kg w/ renal impair Disp: Inj (imipenem/cilastatin) 250/250 mg, 500/500 mg SE: Szs if drug accumulates, GI upset, thrombocytopenia Interactions: ↑ Risks of Szs W/ cyclosporine, ganciclovir; ↑ effects W/ probenicid Labs: ↑ LFTs, BUN, Cr; ↓ HMG, Hct, plts, WBCs NIPE: Eval for super Infxn 160 Imipramine

Imipramine (Tofranil) [Antidepressant/TCA] WARNING: Close observation for suicidal thinking or unusual changes in behavior Uses: *Depres- sion, enuresis*, panic attack, chronic pain Action: TCA; ↑ CNS synaptic serotonin or norepinephrine Dose: Adults. Hospitalized: Initial 100 mg/24 h PO in ÷ doses; ↑ over several wk 300 mg/d max. Outpatient: Maint 50–150 mg PO hs, 300 mg/24 h max. Peds. Antidepressant: 1.5–5 mg/kg/24 h ÷ daily–qid. Enuresis: >6 y: 10–25 mg PO qhs; ↑ by 10–25 mg at 1–2-wk intervals (max 50 mg for 6–12 y, 75 mg for >12 y); Rx for 2–3 mo, then taper Caution: [D, ?/–] Contra: Use with MAOIs, NAG, acute recovery from MI, PRG, CHF, angina, CVD, arrhythmias Disp: Tabs 10, 25, 50 mg; caps 75, 100, 125, 150 mg SE: CV Sxs, dizziness, xerostomia, discolored urine Interactions: ↑ Effects W/ amiodarone, anticholinergics, BBs, cimetidine, diltiazem, Li, OCPs, quinidine, phenothiazines, ritonavir, verapamil, EtOH, evening primrose oil; ↑ effects OF CNS depressants, hypoglycemics, warfarin; ↑ risk of serotonin synd W/ MAOIs; ↓ effects W/ tobacco; ↓ effects OF clonidine Labs: ↑ Serum glucose, LFTs NIPE: D/C 48 h before surgery; D/C MAOIs 2 wk before admin this drug; 4–6 wk for full effects; take w/ food; less sedation than amitriptyline Imiquimod Cream, 5% (Aldara) [Topical Immunomodulator] Uses: *Anogenital warts, HPV, condylomata acuminata* Action: Unknown; ? cytokine induction Dose: Apply 3 ×/wk, leave on 6–10 h & wash off w/ soap & water, continue 16 wk max Caution: [B, ?] Contra: Component sensitivity Disp: Single-dose packets 5% (250 mg cream) SE: Local skin Rxns NIPE: Condoms & vag diaphragms may be weakened—N contact; wash hands before & after use; not a cure Immune Globulin, IV (Gamimune N, Sandoglobulin, Gam- mar IV) [Immune Serum/Immunologic Agent] Uses: *IgG Ab deficiency Dz states, (eg, congenital agammaglobulinemia, CVH, & BMT), HIV, Hep A prophylaxis, ITP* Action: IgG supl Dose: Adults & Peds. Immunodefi- ciency: 100–200 mg/kg/mo IV at 0.01–0.04 mL/kg/min to 400 mg/kg/dose max. ITP: 400 mg/kg/dose IV daily × 5 d. BMT: 500 mg/kg/wk; ↓ in renal insuff Caution: [C, ?] Separate administration of live vaccines by 3 mo Contra: IgA deficiency w/ Abs to IgA, severe thrombocytopenia or coagulation disorders Disp: Inj SE: Associated mostly w/ inf rate; GI upset Interactions: ↓ Effects OF live virus vaccines Labs: ↑ BUN, Cr NIPE: Give live virus vaccines 3 mo after this drug; rapid inf can cause anaphylactoid Rxn Immune Globulin, Subcutaneous (Vivaglobin) [Immune Serum] Uses: *Primary immunodeficiency* Action: IgG supl Dose: 100–200 mg/kg BW subq weekly abdomen, thighs, upper arms, or lateral hip Caution: [C, ?] Contra: h/o anaphylaxis to immune globulin; some IGA deficiency Disp: 10- & 20-mL vials w/ 160 mg/IgG/mL SE: Inj site Rxns, HA, GI complaint, fever, N, D, rash, sore throat NIPE: May instruct in home administration; keep refrigerated; discard unused drug Indomethacin 161

Inamrinone [Amrinone] (Inocor) [Inotropic/Vasodilator] Uses: *Acute CHF, ischemic cardiomyopathy* Action: Inotrope w/ vasodilator Dose: IV bolus 0.75 mg/kg over 2–3 min; maint 5–10 μg/kg/min, 10 mg/kg/d max; ↓ if ClCr <10 mL/min Caution: [C, ?] Contra: Bisulfite allergy Disp: Inj 5 mg/mL SE: Monitor fluid, electrolyte, & renal changes Interactions: Diuretics cause significant hypovolemia; ↑ effects OF cardiac glycosides Labs: Monitor LFTs NIPE: Monitor I&O, daily wt, BP, pulse; incompatible w/ dextrose solns; observe for arrhythmias Indapamide (Lozol) [Antihypertensive/Thiazide Diuretic] ↑ Uses: *HTN, edema, CHF* Action: Thiazide diuretic; Na, Cl, & H2O excretion in distal tubule Dose: 1.25–5 mg/d PO Caution: [D, ?] ↑ Effect w/ loop diuretics, ACE inhibitors, cyclosporine, digoxin, Li Contra: Anuria, thiazide/sulfonamide allergy, renal insuff, PRG Disp: Tabs 1.25, 2.5 mg SE: ↓ BP, dizziness, photosens Interactions: ↑ Effects W/ antihypertensives, diazoxide, nitrates, EtOH; ↑ effects OF ACEIs, Li; ↑ risk of hypokalemia W/ amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin; ↓ effects W/ cholestyramine, colestipol, NSAIDs Labs: ↑ Serum glucose, cholesterol, uric acid, ↓ K+, Na, Cl NIPE: ↑ Risk photosensitivity—use sunscreen; take w/ food; no additional effects w/ doses >5 mg; take early to avoid nocturia Indinavir (Crixivan) [Antiretroviral/Protease Inhibitor] Uses: *HIV Infxn* Action: Protease inhibitor; ↓ maturation of noninfectious virions to mature infectious virus Dose: 800 mg PO q8h; in combo w/ other antiretrovirals; on empty stomach; ↓ w/ hepatic impair Caution: [C, ?] Numerous drug interactions Contra: w/ triazolam, midazolam, pimozide, ergot alkaloids, simvastatin, lovastatin, sildenafil, St. John’s wort, amiodarone Disp: Caps 100, 200, 333, 400 mg SE: Nephrolithiasis, dyslipidemia, lipodystrophy, GI effects Interactions: ↑ Effects W/ azole antifungals, clarithromycin, delavirdine, interleukins, quinidine, zidovudine; ↑ effects OF amiodarone, cisapride, clarithromycin, ergot alkaloids, fentanyl, HMG-CoA reductase inhibitors, INH, OCPs, phenytoin, rifabutin, ritonavir, sildenafil, stavudine, zidovudine; ↓ effects W/ efavirenz, fluconazole, phenytoin, rifampin, St. John’s wort, high-fat/protein foods, grapefruit juice; ↓ effects OF midazolam, triazolam Labs: ↑ Serum glucose, LFTs, ↓ HMG, plts, neutrophils NIPE: ↑ Fluids 1–2 L/d, caps moisture sensitive—keep dessicant in container Indomethacin (Indocin) [Analgesic, Anti-inflammatory, Antipyretic/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis; close ductus arteriosus; ankylosing spondylitis* Action: ↓ Prostaglandins Dose: Adults. 25–50 mg PO bid–tid, max 200 mg/d. Infants: 0.2–0.25 mg/kg/dose IV; may repeat in 12–24 h up to 3 doses; w/ food Caution: [B, +] Contra: ASA/NSAID sensitivity, peptic ulcer/active GI bleed, precipitation of asthma/urticaria/rhinitis by NSAIDs/ASA, premature neonates w/ NEC, ↓ renal Fxn, active bleeding, thrombocytopenia, 3rd tri PRG Disp: Inj 1 mg/vial; caps 25, 50 mg; SR caps 75 mg; susp 25 mg/5 mL SE: GI bleeding or 162 Infliximab upset, dizziness, edema Interactions: ↑ Effects W/ acetaminophen, anti-inflamma- tories, gold compounds, diflunisal, probenicid; ↑ effects OF aminoglycosides, anticoagulants, digoxin, hypoglycemics, Li, MTX, nifedipine, phenytoin, penicillamine, verapamil; ↓ effects W/ ASA; ↓ effects OF antihypertensives Labs: ↑ LFTs, serum K+, BUN, Cr, ↓ HMG, Hct, leukocytes, plts NIPE: Take w/ food Infliximab (Remicade) [Anti-inflammatory/Monoclonal An- tibody] WARNING: TB, invasive fungal Infxns, & other opportunistic Infxns reported, some fatal; perform TB skin testing prior to use; possible association with rare lymphoma Uses: *Moderate–severe Crohn Dz; fistulizing Crohn Dz; ulcerative colitis; RA (w/ MTX) psoriasis, ankylosing spondylitis* Action: IgG1K neutralizes TNF-a Dose: Adult: Crohn Dz: Induction: 5 mg/kg IV inf, w/ doses 2 & 6 wk after. Maint: 5 mg/kg IV inf q8wk. RA: 3 mg/kg IV inf at 0, 2, 6 wk, then q8wk. Peds >6 y: 5 mg/kg IV q8wk Caution: [B, ?/–] Active Infxn, hepatic impairment, h/o or risk of TB, Hep B Contra: Murine allergy, moderate–severe CHF, live w/ live vaccines (eg, smallpox) Disp: 100 mg Inj SE: Allergic Rxns; HA, fatigue, GI upset, inf Rxns; hepatotox; reactivation Hep B, pneumonia, BM suppression, systemic vasculitis, pericardial effusion Interactions: May ↓ effects OF live virus vaccines Labs: Monitor LFTs; PPD at baseline; monitor Hep B carrier; NIPE: ↑ Susceptibility to Infxn; skin exam for malignancy w/ psoriasis Influenza Vaccine (Fluarix, Flulaval, Fluzone, Fluvirin) [An- tiviral/Vaccine] Uses: *Prevent influenza* in adults >50 y, children 6–23 mo, PRG women (2nd/3rd tri during flu season), nursing home residents, chronic Dzs, health care workers, household contacts of high-risk pts, children <9 y receiving vaccine for the 1st time Action: Active immunization Dose: Adults and Peds >9 y. 0.5 mL/dose IM annually Peds.6 mo >3 y: 0.25 mL IM annually; 0.25 mL IM × 2 doses >4 wk apart 1st vaccination; give 2 doses in 2nd vaccination year if only 1 dose given in 1st year–; 3–8 y: 0.5 mL IM annually, start 0.5 mL IM × 2 doses 4> wk >in 1st vaccination year Caution: [C, +] Contra: Egg, gentamicin, or thimerosal allergy, Infxn at site, acute resp or febrile illness, h/o Guillain–Barré synd, immunocompromised, children 5–17 y on ASA Disp: Based on manufacturer, 0.25- & 0.5-mL prefilled syringes SE: Inj site soreness, fever, myalgia, malaise, Guillain–Barré synd (controversial) Interactions: ↑ Effects OF theophylline, warfarin; ↓ effects W/ corticosteroids, immunosuppressants; ↓ effects OF aminopyrine, phenytoin NIPE: Fluvarix not labelled for peds; Optimal in US Oct–Nov, protection begins 1–2 wk after, lasts up to 6 mo; each y, vaccines based on predictions of flu active in flu season (Dec–spring in US); whole or split virus for adults; peds <13 y split virus or purified surface antigen to ↓ febrile Rxns; www.cdc.gov/flu for more info Influenza Virus Vaccine Live, Intranasal (FluMist) [Antiviral/ Vaccine] Uses: *Prevent influenza* Action: Live-attenuated vaccine Dose: Adults 18–49 y: 1 0.1 mL each nostril × 1 annually Peds 5–8 yo: 0.1 mL each nostril × 1 annually; Initial 0.1 mL each nostril × 2 doses >6 wk apart in Interferon Alfa 163

1st vaccination year Peds >9 y: See adult dose Caution: [C,?/–] Contra: Egg allergy, PRG, h/o Guillain–Barré synd, known/suspected immune deficiency, asthma or reactive airway Dz, acute febrile illness, 5–17 y on ASA Disp: Pre- filled, single-use, intranasal sprayer; shipped frozen, store 35–46°F; new refrigerated shipping form for 2008 SE: Runny nose, nasal congestion, HA, cough NIPE: N Take W/ antivirals, ASA, NSAIDs, immunosuppressants, corticosteroids, radiation therapy; do not give w/ other vaccines; avoid contact w/ immunocompromised individuals for 21 d Insulin, Injectable [Hypoglycemic/Hormone] (See Table 5) Uses: *Type 1 or type 2 DM refractory to diet or PO hypoglycemic agents; acute life-threatening ↑ K+* Action: Insulin supl Dose: Based on serum glucose; usually SQ; can give IV (only regular)/IM; type 1 typical start dose 0.5–1 units/kg/d; type 2 0.3–0.4 units/kg/d; renal failure ↓ insulin needs Caution: [B, +] Contra: Hypo- glycemia Disp: See Table 5 SE: Highly purified insulins ↑ free insulin; monitor for several wk when changing doses/agents Interactions: ↑ Hypoglycemic effects W/ α-blockers, anabolic steroids, BBs, clofibrate, fenfluramine, guanethidine, MAOIs, NSAIDs, pentamidine, phenylbutazone, salicylates, sulfinpyrazone, tetracyclines, EtOH, celery, coriander, dandelion root, fenugreek, ginseng, garlic, juniper berries; ↓ hypoglycemic effects W/ corticosteroids, dextrothyroxine, diltiazem, dobutamine, epinephrine, niacin, OCPs, protease inhibitor antiretrovirals, rifampin, thiazide diuretics, thyroid preps, marijuana, tobacco NIPE: If mixing insulins, draw up short-acting preps 1st in syringe Withdrawn from US market Insulin Human Inhalation Powder (Exubera) [Hypo- glycemic/Hormone] Uses: *Type 1 DM in adults combo w/ LA insulin; Type 2 DM monotherapy or w/ other agents Action: Regulates glucose metabolism Dose: Premeal (mg) = BW(kg) × 0.05 mg/kg; round down to nearest whole mg; give w/in 10 min pc; titrate based on glucose; 1 mg blister = 3 IU of SC regular human insulin; 3 mg blister = 8 IU of SC regular human insulin. Caution: [C, M] Contra: Smoker/or D/C smoking <6 mo before start; D/C if smoking resumes; unstable or poorly controlled lung disease Disp: Unit dose blisters: 1, 3 mg w/ Exu- bera Inhaler SE: Hypoglycemia, dry mouth, chest pain, otitis media, cough, dyspnea, pharyngitis, rhinitis, sinusitis, epistaxis, ↑ sputum Interactions: ↑ Effects W/ albuterol w/in 30 min; salicylates, MAOIs, sulfonamides, ACEIs, active cigarette smoke; ↓ aborption W/ bronchodilators and other inhaled agents; ↓ effects W/ corticosteroids, thiazides, phenothiazines, sympathomimetics, and passive cigarette smoke; Labs: Pulm Fxn before Tx and 6–12 mo NIPE: Assess pulmonary Fxn before Tx and 6–12 mo; store blisters at room temperature Interferon Alfa (Roferon-A, Intron-A) [Antineoplastic/ Immunomodulator] WARNING: Can cause or aggravate fatal or life- threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely Uses: *Hairy cell leukemia, Kaposi sarcoma, melanoma, 164 Interferon Alfa-2b & Ribavirin Combo

CML, chronic Hep B & C, follicular NHL, condylomata acuminata* Action: An- tiproliferative; modulates host immune response; ↓ viral replication in infected cells Dose: Per protocols. Adults. Hairy cell leukemia: Alfa-2a (Roferon-A): 3 M units/d for 16–24 wk SQ/IM then 3 M units 3 ×/wk × 6–24 mo; Alfa-2b (Intron A): 2 M units/m2 IM/ SQ 3 ×/wk for 2–6 mo Chronic Hep B: Alfa-2b (Intron A): 3 M units/m2 SQ 3 ×/wk × 1 wk, then 6 M units/m2 3 ×/wk (max 10 M units 3 ×/wk, total duration 16–24 wks). Follicular NHL: (Intron A) 5 M units SQ 3 ×/wk for 18 mo; Melanoma: (Intron A) 20 M units m2 IV × 5 d/wk × 4 wk, then 10 M units/m2 SQ 3 ×/wk × 48 wks; Kaposi sarcoma: (Intron A) 30 M units/m IM/SQ 3 ×/wk × 10–12 wk, then 36 M units IM/SQ 3 ×/wk; Chronic hep C: (Intron A) 3 m units 3 ×/wk × 16 wk (continue 18–24 mo if response) Roferon A: 3 M units 3 ×/wk for 12 mo SQ/IM; Condyloma: (Intron A) 1 M units/lesion (max 5 lesions) 3 ×/wk for 3 wk. Peds. CML: Alfa-2a (Roferon-A): 2.5–5 M units/m2 IM daily. Contra: Benzyl alcohol sens, decompensated liver Dz, autoimmune Dz, immunosuppressed, neonates, infants Disp: Inj forms (see also PEG interferon) SE: Flu-like Sxs, fatigue, anorexia, neurotox at high doses; up to 40% neutralizing Ab w/ therapy Interactions: ↑ Effects OF antineoplastics, CNS depressants, doxorubicin, theophylline; ↓ effects OF live virus vaccine Labs: ↑ LFTs, BUN, SCr, glucose, phosphorus, ↓ HMG, Hct, Ca NIPE: ASA & EtOH use may cause GI bleed, ↑ fluids to 2–3 L/d Interferon Alfa-2b & Ribavirin Combo (Rebetron) [Antineo- plastic/Immunomodulator] WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely. Contraindicated in PRG females & their male partners Uses: *Chronic Hep C in pts w/ compensated liver Dz who relapse after α-interferon therapy* Action: Combo antiviral agents (see individual agents) Dose: 3 M units In- tron A SQ 3 × wk w/ 1000–1200 mg of Rebetron PO ÷ bid dose for 24 wk. Pts <75 kg: 1000 mg of Rebetron/d Caution: [X, ?] Contra: PRG, males w/ PRG female partner, autoimmune hepatitis, CrCl <50 mL/min Disp: Pts <75 kg: Combo packs: 6 vials Intron A (3 M units/0.5 mL) w/ 6 syringes & EtOH swabs, 70 Rebetol caps; one 18-M unit multidose vial of Intron A inj (22.8 M units/3.8 mL; 3 M units/0.5 mL) & 6 syringes & swabs, 70 Rebetol caps; one 18 M units Intron A inj multidose pen (22.5 M units/1.5 mL; 3 M units/0.2 mL) w/ 6 needles & swabs, 70 Rebetol caps. Pts >75 kg: Identical except 84 Rebetol caps/pack SE: See Warning, flu-like Sxs, HA, anemia NIPE: Monthly PRG test; instruct in self-administration of SQ Intron A Interferon Alfacon-1 (Infergen) [Immunomodulator] WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely Uses: *Chronic Hep C* Action: Biologic response modifier Dose: 9 μg SQ 3 ×/wk × 24 wk Caution: [C, M] Contra: E. coli product allergy Disp: Inj 9, 15 μg SE: Flulike Sxs, depression, blood dyscrasias, colitis, pancreatitis, hepatic decompensation, ↑ SCr, eye disorders, ↓ thyroid Interactions: ↑ Effects OF theophylline Ipecac Syrup 165

Labs: ↑ Triglycerides, TSH; ↓ HMG, Hct; monitor CBC, plt, SCr, TFT NIPE: Refrigerate; N shake; use barrier contraception; allow >48 h between inj Interferon Beta-1a (Rebif) [Immunomodulator] WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely Uses: *MS, relapsing* Action: Biologic response modifier Dose: 44 μg SC 3 ×/wk; start 8.8 μg SC 3 ×/wk × 2 wk, then 22 μg SC 3 ×/wk × 2 wk Caution: [C, ?] w/ hepatic impair, depression, Sz disorder, thyroid Dz Contra: Human albumin allergy Disp: 0.5 mL prefilled syringes w/ 29 gauze needle titrate pak 8.8 and 22 μg; 22 or 44 μg SE: Inj site Rxn, HA, flu-like Sx, malaise, fatigue, rigors, myalgia, depression w/ suicidal ideation, hepatotox, ↓ BM Interactions: Caution with other hepatotoxic drugs Labs: Monitor CBC 1, 3, 6 mo; TFTs q6mo w/ h/o thyroid Dz NIPE: Dose >48 h apart; D/C if jaundice occurs; may have abortifacient effects Interferon Beta-1b (Betaseron) [Immunomodulator] Uses: *MS, relapsing/remitting/secondary progressive* Action: Biologic response modifier Dose: 0.25 mg SQ qod Caution: [C, ?] Contra: Human albumin allergy Disp: Powder for inj 0.3 mg (32 M units inf) SE: Flu-like Sxs, depression, blood dyscrasias, inj site necrosis, anaphylaxis Interactions: ↑ Effects OF theophylline, zidovudine Labs: ↑ LFTs, BUN, urine protein; monitor LFTs, CBC 1, 3, 6 mo, TFT q6mo NIPE: ↑ Risk OF photosensitivity—use sunscreen, abortion; ↑ fluid intake, use barrier contraception; pt self inj, rotate sites Interferon Gamma-1b (Actimmune) [Immunomodulator] Uses: *↓ Incidence of serious Infxns in chronic granulomatous Dz (CGD), osteoporosis* Action: Biologic response modifier Dose: Adults. CGD: 50 μg/m2 SQ (1.5 M units/m2) BSA >0.5 m2; if BSA <0.5 m2, give 1.5 μg/kg/dose; given 3 × wk. Caution: [C, ?] Contra: Allergy to E. coli-derived products Disp: Inj 100 μg (2 M units) SE: Flulike Sxs, depression, blood dyscrasias, dizziness, altered mental status, gait disturbance, hepatic tox Interactions: ↑ Myelosuppression W/ myelosup- presive drugs Labs: ↑ LFTs; ↓ neutrophils, plts NIPE: small freq meals will decrease GI upset; rotate inj sites Ipecac Syrup [OTC] [Antidote] Uses: *Drug OD, certain cases of poisoning* NOTE: Usage is falling out of favor & is no longer recommended by some groups Action: Irritation of the GI mucosa; stimulation of the chemoreceptor trigger zone Dose: Adults. 15–30 mL PO, followed by 200–300 mL of H2O; if no emesis in 20 min, repeat once. Peds. 6–12 y: 5–10 mL PO, followed by 10–20 mL/kg of H2O; if no emesis in 20 min, repeat once. 1–12 y: 15 mL PO followed by 10–20 mL/kg of H2O; if no emesis in 20 min, repeat once Caution: [C, ?] Contra: Ingestion of petroleum distillates, strong acid, base, or other caustic agents; comatose/unconscious Disp: Syrup 15, 30 mL (OTC) SE: Lethargy, D, cardiotox, protracted V Interac- tions: ↑ Effects OF myelosuppressives, theophylline, zidovudine NIPE: ↑ Fluids to 2–3 L/d, N EtOH, CNS depressants; activated charcoal considered more effective; caution in CNS depressant OD (www.clintox.org/PosStatements/Ipecac.html) 166 Ipratropium

Ipratropium (Atrovent HFA, Atrovent Nasal) [Bronchodilator/ Anticholinergic] Uses: *Bronchospasm w/ COPD, rhinitis, rhinorrhea* Action: Synthetic anticholinergic similar to atropine; antagonizes acetylcholine receptors, inhibits mucous gland secretions Dose: Adults & Peds >12 y. 2–4 puffs qid, max 12 inh/d Nasal: 2 sprays/nostril bid–tid; Nebulization: 500 μg 3–4 times/d Caution: [B, +/–] w/ inhal insulin Contra: Allergy to soya lecithin/related foods Disp: HFA Met-dose inhal 18 μg/dose; inhal soln 0.02%; nasal spray 0.03, 0.06% SE: Nervousness, dizziness, HA, cough, bitter taste, nasal dryness, URI, epistaxis Interactions: ↑ Effects W/ albuterol; ↑ effects OF anticholinergics, antimuscarinics; ↓ effects W/ jaborandi tree, pill-bearing spurge NIPE: Adequate fluids; separate inhalation of other drugs by 5 min; not for acute bronchospasm Irbesartan (Avapro) [Antihypertensive/ARB] Uses: *HTN, DN*, CHF Action: Angiotensin II receptor antagonist Dose: 150 mg/d PO, may ↑ to 300 mg/d Caution: [C (1st tri; D 2nd/3rd tri), ?/–] Disp: Tabs 75, 150, 300 mg SE: Fa- tigue, ↓ BP ↑ K Interactions: ↑ Risk of hyperkalemia W/ K-sparing diuretics, trimethoprim, K supls; ↑ effects OF Li Labs: ↑ K+ (monitor) NIPE: N PRG, breast-feeding Irinotecan (Camptosar) [Antineoplastic] WARNING: D and myelosuppression Uses: *Colorectal* & lung CA Action: Topoisomerase I inhibitor; ↓ DNA synth Dose: Per protocol; 125–350 mg/m2 qwk–q3wk (↓ hepatic dysfunction, as tolerated per tox) Caution: [D, –] Contra: Allergy to component Disp: Inj 20 mg/mL SE: ↓ BM, N/V/D, abd cramping, alopecia; D is dose limiting; Rx acute D w/ atropine; Rx subacute D w/ loperamide Interactions: ↑ Effects OF antineoplastics; ↑ risk OF akathisia W/ prochlorperazine Labs: ↑ LFTs NIPE: Use barrier contraception; N exposure to Infxn; D correlated to levels of metabolite SN-38 Iron Dextran (Dexferrum, INFeD) [Iron Supplement] WARN- ING: Anaphylactic Rxns with use; use only if oral Fe not possible; administer where resuscitation techniques available Uses: *Fe deficiency when cannot supplement PO* Action: Fe supl Dose: Adults. Iron defic anemia: Estimate Fe deficiency, give 25–100 mg IM/IV day until total dose; total dose (mL) = [–.0442 × (desired Hgb – observed Hgb) × LBW] + (0.26 × LBW); Iron replacement, blood loss: total dose (mg) = blood loss (mL) × Hct (as decimal fraction) max 100 mg/d; Peds >4 mo. As above; max: 0.5 mL (wt <5 kg), 1 mL (5–10 kg), 2 mL (>10 kg) per dose IM or direct IV Caution: [C, M] Contra: Anemia w/o Fe deficiency. Disp: Inj 50 mg (Fe)/mL SE: Anaphylaxis, flushing, dizziness, inj site & inf Rxns, metallic taste Interactions: ↓ Effects W/ chloramphenicol, ↓ absorption OF oral Fe Labs: False ↓ serum Ca; false + guaiac test NIPE: N Take oral Fe; give IM w/ “Z-track” technique; IV preferred; give test dose >1 h before Iron Sucrose (Venofer) [Iron Supplement] Uses: *Fe deficiency anemia w/ chronic HD in those receiving erythropoietin* Actions: Fe replacement. Dose: 5 mL (100 mg) IV on dialysis, 1 mL (20 mg)/min max Caution: [C, M] Contra: Anemia w/o Fe deficiency Disp: 20 mg elemental Fe/mL, 5-mL vials. Isosorbide Dinitrate 167

SE: Anaphylaxis, ↓ BP, cramps, N/V/D, HA Interactions: ↓ Absorption OF oral Fe supls Labs: Monitor ferritin, HMG, Hct, transferrin saturation; obtain Fe levels 48 h > IV dose; ↑ LFTs NIPE: N use oral & IV supls together; most pts require cumulative doses of 1000 mg; give slowly Isoniazid (INH) [Antitubercular] Uses: *Rx & prophylaxis of TB* Action: Bactericidal; interferes w/ mycolic acid synth, disrupts cell wall Dose: Adults. Active TB: 5 mg/kg/24 h PO or IM (usually 300 mg/d) or DOT: 15mg/kg (max 900 mg) 3 ×/wk. Prophylaxis: 300 mg/d PO for 6–12 mo or 900 mg 2 ×/wk. Peds. Active TB: 10–15 mg/kg/d daily–bid PO or IM 300 mg/d max. Prophylaxis: 10 mg/kg/24 h PO; ↓ in hepatic/renal dysfunction Caution: [C, +] Liver Dz, dialysis; avoid EtOH Contra: Acute liver Dz, h/o INH hepatitis Disp: Tabs 100, 300 mg; syrup 50 mg/5 mL; inj 100 mg/mL SE: Hepatitis, peripheral neuropathy, GI upset, anorexia, dizziness, skin Rxn Interactions: ↑ Effects OF acetaminophen, anticoagulants, carbamazepine, cycloserine, diazepam, meperidine, hydantoins, theophylline, valproic acid, EtOH; ↑ effects W/ rifampin; ↓ effects W/ Al salts; ↓ effects OF anticoagulants, ketoconazole Labs: ↑ LFTs, glucose; ↓ HMG, plts, WBCs NIPE: Only take w/ food if GI upset; use w/ 2–3 other drugs for active TB, based on INH resistance patterns when TB acquired & sensitivity results; prophylaxis usually w/ INH alone. IM rarely used. ↓ peripheral neuropathy w/ pyridoxine 50–100 mg/d. CDC guidelines (MMWR) for current recommendations Isoproterenol (Isuprel) [Bronchodilator/Sympathomimetic] β β Uses: *Shock, cardiac arrest, AV nodal block* Action: 1- & 2-receptor stimulant Dose: Adults. 2–10 μg/min IV inf; titrate; 2–10 μg/min titrate (ECC 2005) Peds. 0.2–2 μg/kg/min IV inf; titrate. Caution: [C, ?] Contra: Angina, tachyarrhythmias (digitalis-induced or others) Disp: 0.02 mg/mL, 0.2 mg/mL SE: Insomnia, arrhythmias, HA, trembling, dizziness Interactions: ↑ Effects W/ albuterol, guanethidine, oxytocic drugs, sympathomimetics, TCAs; ↑ risk of arrhythmias W/ amitriptyline, bretylium, cardiac glycosides, K-depleting drugs, theophylline; ↓ effects W/ BBs Labs: False ↑ serum AST, bilirubin, glucose NIPE: Saliva may turn pink in color, ↑ β β fluids to 2–3 L/d; more specific 2-agonists preferred d/t excessive 1 cardiac stimulation of drug; drug induces ischemia & dysrhythmias; pulse >130 bpm may induce arrhythmias Isosorbide Dinitrate (Isordil, Sorbitrate, Dilatrate-SR) [An- tianginal/Nitrate] Uses: *Rx & prevent angina*, CHF (w/ hydralazine) Action: Relaxes vascular smooth muscle Dose: Acute angina: 5–10 mg PO (chew tabs) q2–3h or 2.5–10 mg SL PRN q5–10 min; do not give >3 doses in a 15–30-min period. Angina prophylaxis: 5–40 mg PO q6h; do not give nitrates on a chronic q6h or qid basis >7–10 d; tolerance may develop; provide 10–12-h drug-free intervals Caution: [C, ?] Contra: Severe anemia, NAG, postural ↓ BP, cerebral hemorrhage, head trauma (can ↑ ICP), w/ sildenafil, tadalafil, vardenafil Disp: Tabs 5, 10, 20, 30; SR tabs 40 mg; SL tabs 2.5, 5, mg; SR caps 40 mg SE: HA, ↓ BP, flushing, tachycardia, dizziness Interactions: ↑ Hypotension W/ antihypertensives, 168 Isosorbide Dinitrate & Hydralazine HCL

ASA, CCBs, phenothiazides, sildenafil, EtOH Labs: False ↓ serum cholesterol NIPE: N Nitrates for an 8–12-h period/d to avoid tolerance; higher PO dose needed for same results as SL forms Isosorbide Dinitrate & Hydralazine HCL (BiDil) [Antianginal, Antihypertensive/Vasodilator, Nitrate] Uses: HF in AA pts; improve survival & functional status, prolong time between hospitalizations for HF Action: Relaxes vascular smooth muscle; peripheral vasodilator Dose: Initially. 1 tab tid PO (if not tolerated reduce to 1/2 tab tid), titrate >3–5 d as tolerated. Max: 2 tabs tid Caution [C, ?/–] recent MI, syncope, hypovolemia, hypotension, hep impair Contra: N For children, concomitant use w/ PDE5 inhibitors (sildenafil) Disp: Isosorbide dinitrate 20 mg/hydralazine HCL 37.5 mg tabs SE: HA, dizziness, orthostatic hypotension, sinusitis, GI distress, tachycardia, paresthesia, am- blyopia Interactions: ↑ Risk of severe hypotension W/ antihypertensives, ASA, CCBs, MAOIs, phenothiazides, sidenafil, tadalafil, vardenafil, ETOH; ↓ pressor response W/ epinephrine; ↓ effects W/ NSAIDs Labs: False ↓ serum cholesterol NIPE: N Nitrates for an 8–12-h period/d to avoid tolerance; take w/food Isosorbide Mononitrate (Ismo, Imdur) [Antianginal/Nitrate] Uses: *Prevention/Rx of angina pectoris* Action: Relaxes vascular smooth muscle Dose: 5–10 mg PO bid, w/ the 2 doses 7 h apart or XR (Imdur) 30–60 mg/d PO, max 240 mg Caution: [C, ?] Contra: Head trauma/cerebral hemorrhage (can ICP), w/ sildenafil, tadalafil, vardenafil Disp: Tabs 10, 20 mg; XR 30, 60, 120 mg SE: HA, dizziness, ↓ BP; Interactions: ↑ Hypotension w/ ASA, CCB, nitrates, sildenafil, EtOH Labs: False ↓ serum cholesterol Isotretinoin [13-cis Retinoic Acid] (Accutane, Amnesteem, Claravis, Sotret) [Anti-acne Agent] WARNING: Must not be used by PRG females; can induce severe birth defects; pt must be capable of complying w/ mandatory contraceptive measures; prescribed according to product-specific risk management system. Because of teratogenicity, Accutane is approved for mar- keting only under a special restricted distribution FDA program called iPLEDGE Uses: *Refractory severe acne* Action: Retinoic acid derivative Dose: 0.5–2 mg/kg/d PO ÷ bid; ↓ in hepatic Dz, take w/ food Caution: [X, –] Avoid tetracyclines Contra: Retinoid sensitivity, PRG Disp: Caps 10, 20, 30, 40 mg SE: Rare: Depression, psychosis, suicidal thoughts; derm sensitivity, xerostomia, photosens, LFTs, triglycerides; Interactions: ↑ Effects W/ corticosteroids, phenytoin, vitamin A; ↑ risk of pseudotumor cerebri w/ tetracyclines; ↑ triglyceride levels w/ EtOH; ↓ effects of carbamazepine Labs: ↑ LFTs, triglycerides; NIPE: ↑ Risk of photosensitivity—use sunscreen, take w/ food, N PRG; low dose progesterone only hormonal contraceptives may not be adequate birth control alone; Risk management program requires 2 (–) PRG tests before Rx & use of 2 forms of contraception 1 mo before, during, & 1 mo after therapy; to prescribe isotretinoin, the prescriber must access the iPLEDGE system via the Internet (www.ipledgeprogram.com); monitor LFTs & lipids Ketoconazole 169

Isradipine (DynaCirc) [Antihypertensive/CCB] Uses: *HTN* Action: CCB Dose: Adults. 2.5–5 mg PO bid. Caution: [C, ?] Contra: Severe heart block, sinus bradycardia, CHF, dosing w/in several hours of IV β-blockers Disp: Caps 2.5, 5 mg; tabs CR 5, 10 mg SE: HA, edema, flushing, fatigue, dizziness, palpitations Interactions: ↑Effects W/ azole antifungals, BBs, cimetidine; ↑ effects OF carbamazepine, cyclosporine, digitalis glycosides, prazosin, quinidine; ↓ effects W/ Ca, rifampin; ↓ effects OF lovastatin Labs: ↑ LFTs NIPE: N D/C abruptly Itraconazole (Sporanox) [Antifungal] WARNING: Potential for negative inotropic effects on the heart; if signs or Sxs of CHF occur during administration, continued use should be assessed Uses: *Fungal Infxns (aspergillosis, blastomycosis, histoplasmosis, candidiasis)* Action: ↓ Ergosterol synth Dose: 200 mg PO or IV daily–bid (capsule w/ meals or cola/grapefruit juice); PO soln on empty stomach; avoid antacids Caution: [C, ?] Numerous interactions Contra: Inj. if CrCl <30 mL/min, h/o CHF or ventricular dysfunction, w/ H2-antagonist, omeprazole Disp: Caps 100 mg; soln 10 mg/mL; inj 10 mg/mL SE: N, rash, hepatitis, ↓ K+, CHF (mostly w/ IV use) Interactions: ↑ Effects W/ clarithromycin, erythromycin; ↑ effects OF alprazolam, anticoagulants, atevirdine, atorvastatin, buspirone, cerivastatin, chlordiazepoxide, cyclosporine, diazepam, digoxin, felodipine, fluvastatin, indinavir, lovastatin, methadone, methylprednisolone, midazolam, nelfinavir, pravastatin, ritonavir, saquinavir, simvastatin, tacrolimus, tolbutamide, triazolam, warfarin; ↑ QT prolongation W/ astemizole, cisapride, pimozide, quinidine, terfenadine; ↓ effects W/ antacids, Ca, cimetidine, didanosine, famotidine, lansoprazole, Mg, nizatidine, omeprazole, phenytoin, rifampin, sucralfate, grapefruit juice Labs: ↑ LFTs, BUN, SCr NIPE: Take capsule w/ food & soln w/o food, N PRG or breast-feeding, ↑ risk of disulfiram-like response w/ EtOH; PO soln & caps not interchangeable; useful in pts who cannot take ampho B, can cause ↑ QTc in combo w/ other drugs Kaolin-Pectin (Kaodene, Kao-Spen, Kapectolin) [Antidiar- rheal/Absorbent] [OTC] Uses: *D* Action: Absorbent demulcent Dose: Adults. 60–120 mL PO after each loose stool or q3–4h PRN. Peds. 3–6 y: 15–30 mL/dose PO PRN. 6–12 y: 30–60 mL/dose PO PRN Caution: [C, +] Con- tra: D due to pseudomembranous colitis Disp: Multiple OTC forms; also available w/ opium (Parepectolin [CII]) SE: Constipation, dehydration Interaction: ↓ Effects OF ciprofloxacin, clindamycin, digoxin, lincomycin, lovastatin, penicillamine, quinidine, tetracycline NIPE: Take other meds 2–3 h before or after this drug Ketoconazole (Nizoral, Nizoral AD Shampoo) [Shampoo–OTC] [Antifungal/Imidazole] Uses: *Systemic fungal Infxns; topical for local fungal Infxns due to dermatophytes & yeast; shampoo for dandruff,* PCa when rapid ↓ testosterone needed (ie, cord compression) Action: ↓ Fungal cell wall synth Dose: Adults. PO: 200 mg PO daily; ↑ to 400 mg PO daily for serious Infxn; PCa 400 mg PO tid (short-term). Topical: Apply daily (cream/shampoo). Peds >2 y. 5–10 mg/kg/24 h PO ÷ q12–24h (↓ in hepatic Dz) Caution: [C, +/–] 170 Ketoprofen

Any agent that ↑ gastric pH prevents absorption; may enhance anticoagulants; w/ EtOH (disulfiram-like Rxn) numerous interactions Contra: CNS fungal Infxns (poor CNS penetration), w/ astemizole, triazolam; topical use on broken/inflamed skin Disp: Tabs 200 mg; topical cream 2%; gel 2%, shampoo 1% and 2% SE: N Interactions: ↑ Effects OF alprazolam, anticoagulants, atevirdine, atorvastatin, buspirone, chlordiazepoxide, cyclosporine, diazepam, felodipine, fluvastatin, indinavir, lovastatin, methadone, methylprednisolone, midazolam, nelfinavir, pravastatin, ritonavir, saquinavir, simvastatin, tacrolimus, tolbutamide, triazolam, warfarin; ↑ QT prolongation W/ astemizole, cisapride, quinidine, terfenadine; ↓ effects W/ antacids, Ca, cimetidine, didanosine, famotidine, lansoprazole, Mg, nizatidine, omeprazole, phenytoin, rifampin, sucralfate Labs: ↑ LFTs; monitor LFTs w/ systemic use NIPE: Take tabs w/ citrus juice, take w/ food; shampoo wet hair 1 min, rinse, repeat for 3 min; N PRG or breast-feeding; Ketoprofen (Orudis, Oruvail) [Analgesic/NSAID] WARN- ING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis, pain* Action: NSAID; ↓ prostaglandins Dose: 25–75 mg PO tid–qid, 300 mg/d/max; w/ food Caution: [B (D 3rd tri), ?] Contra: NSAID/ASA sensitivity Disp: Caps 25, 50, 75 mg; caps, SR 100, 150, 200 mg SE: GI upset, peptic ulcers, dizziness, edema, rash Interactions: ↑ Effects W/ ASA, corticosteroids, NSAIDs, probenicid, EtOH; ↑ effects OF antineoplastics, hypoglycemics, insulin, Li, MTX; ↑ risk of nephrotox W/ aminoglycosides, cyclosporines; ↑ risk of bleeding W/ anticoagulants, defamandole, cefotetan, cefoperazone, clopidogrel, eptifibatide, plicamycin, thrombolytics, tirofiban, valproic acid, dong quai, feverfew, garlic, ginkgo biloba, ginger, horse chestnut, red clover; ↓ effects OF antihypertensives, diuretics Labs: ↑ LFTs, BUN, Cr, PT; ↓ plts, WBCs NIPE: ↑ Risk of photosensitivity—use sunscreen, take w/ food Ketorolac (Toradol) [Analgesic/NSAID] WARNING: Indicated for short-term (=5 d) Rx of moderate–severe acute pain that requires opioid analgesia levels Uses: *Pain* Action: NSAID; ↓ prostaglandins Dose: 15–30 mg IV/IM q6h or 10 mg PO qid; max IV/IM 120 mg/d, max PO 40 mg/d; do not use for >5 d; ↓ for age & renal dysfunction and <50 kg Caution: [B (D 3rd tri), –] Contra: Pep- tic ulcer Dz, NSAID sensitivity, advanced renal Dz, CNS bleeding, anticipated major surgery, labor & delivery, nursing mothers Disp: Tabs 10 mg; inj 15 mg/mL, 30 mg/mL SE: Bleeding, peptic ulcer Dz, renal failure, Cr, edema, dizziness, allergy Interactions: ↑ Effects W/ ASA, corticosteroids, NSAIDs, probenicid, EtOH; ↑ effects OF antineoplastics, hypoglycemics, insulin, Li, MTX; ↑ risk of nephrotox W/ aminoglycosides, cyclosporines; ↑ risk of bleeding W/ anticoagulants, defamandole, cefotetan, cefoperazone, clopidogrel, eptifibatide, plicamycin, thrombolytics, tirofiban, valproic acid, dong quai, feverfew, garlic, ginkgo biloba, ginger, horse chestnut, red clover; ↓ effects of antihypertensives, diuretics Labs: ↑ LFTs, PT; ↓ HMG, Hct NIPE: 30-mg dose equals comparative analgesia of meperidine 100 mg or morphine 12 mg; PO only as continuation of IM/IV therapy Lactobacillus 171

Ketorolac Ophthalmic (Acular, Acular LS, Acular PF) [Anal- gesic, Anti-inflammatory/NSAID] Uses: *Ocular itching w/ seasonal allergies*; inflammation w/ cataract extraction; pain/photophobia w/ incisional refractive surgery (Acular PF); pain w/ corneal refractive surgery (Acular LS) Action: NSAID Dose: 1 gtt qid Caution: [C, +] Disp: Acular LS: 0.4%; Acular, Acular PF Soln 0.5% SE: Local irritation NIPE: Teach use of eye drops Ketotifen (Zaditor) [Ophthalmic Antihistamine/Histamine Antagonist & Mast Cell Stabilizer] Uses: *Allergic conjunctivitis* Action: H1-receptor antagonist, mast cell stabilizer Dose: Adults & Peds. 1 gtt in eye(s) q8–12h Caution: [C,?/–] Disp: Soln 0.025%/5 mL SE: Local irritation, HA, rhinitis NIPE: Insert soft contact lenses 10 min after drug use; N wear contact lenses if eyes red Kunecatechins (Veregen) [Botanical] Uses: *External genital/perianal warts* Action: Unknown Dose: Apply 0.5 cm ribbon to each wart 3 ×/d until all warts clear; not >16 wk Caution: [C; ?] Disp: Oint 15% SE: Local Rxns (erythema, pruritus, burning, pain, erosion/ulceration, edema, induration, rash) NIPE: Wash hands before/after use; not necessary to wipe off prior to next use; N internal or mucous membrane warts or on broken skin; N condoms or diaphragm—ointment may weaken rubber Labetalol (Trandate) [Antihypertensive/Alpha & Beta- Blocker] Uses: *HTN* & hypertensive emergencies (IV) Action: α- & β-Adrenergic blocker Dose: Adults. HTN: Initial, 100 mg PO bid, then 200–400 mg PO bid. Hypertensive emergency: 20–80 mg IV bolus, then 2 mg/min IV inf, titrate up to 300 mg; 10 mg IV over 1–2 min; repeat or double dose q10min (150 mg max); or initial bolus, then 2–8 mg/min (ECC 2005) Peds. PO: 3–20 mg/kg/d in ÷ doses. Hypertensive emergency: 0.4–1.5 mg/kg/h IV cont inf Caution: [C (D in 2nd or 3rd tri), +] Contra: Asthma/COPD, cardiogenic shock, uncompensated CHF, heart block Disp: Tabs 100, 200, 300 mg; inj 5 mg/mL SE: Dizziness, N, ↓ BP, fatigue, CV effects Interactions: ↑ Effects W/ cimetidine, diltiazem, nitroglycerine, quinidine, paroxetine, verapamil; ↑ tremors W/ TCAs; ↓ effects W/ glutethimide, NSAIDs, salicylates; ↓ effects OF antihypertensives, β-adrenergic bronchodilators, sulfonylureas Labs: False + amphetamines in urine drug screen; ↑ LFTS NIPE: May have transient tingling of scalp Lactic Acid & Ammonium Hydroxide [Ammonium Lactate] (Lac-Hydrin) [Emollient] Uses: *Severe xerosis & ichthyosis* Action: Emollient moisturizer Dose: Apply bid Caution: [B, ?] Disp: Cream, lotion, lactic acid 12% w/ ammonium hydroxide SE: Local irritation NIPE: N Children <2 y; ↓ sun exposure—use sunscreen; risk of hyperpigmentation Lactobacillus (Lactinex Granules) [Antidiarrheal] [OTC] Uses: * Control of D*, especially after antibiotic therapy Action: Replaces nl intestinal flora Dose: Adults & Peds >3 y. 1 packet, 1–2 caps, or 4 tabs daily–qid Caution: [A, +] Contra: Milk/lactose allergy Disp: Tabs; caps; EC caps; powder in packets (all OTC) SE: Flatulence 172 Lactulose

Lactulose (Constulose, Generlac, Enulose, others) [Laxa- tive/Osmotic] Uses: *Hepatic encephalopathy; constipation* Action: Acidifies the colon, allows ammonia to diffuse into colon Dose: Acute hepatic encephalopathy: 30–45 mL PO q1h until soft stools, then tid–qid. Chronic laxative therapy: 30–45 mL PO tid–qid; adjust q1–2d to produce 2–3 soft stools/d. Rec- tally: 200 g in 700 mL of H2O PR. Peds. Infants: 2.5–10 mL/24 h ÷ tid–qid. Other Peds Peds. 40–90 mL/24 h ÷ tid–qid Caution: [B, ?] Contra: Galactosemia Disp: Syrup 10 g/15 mL, soln 10 g/15 mL, 10, 20 g/packet SE: Severe D, flatulence; life- threatening electrolyte disturbances Interactions: ↓ Effects W/ antacids, antibiotics, neomycin Labs: ↓ Serum ammonia NIPE: May take 24–48 h for results Lamivudine (Epivir, Epivir-HBV) [Antiretroviral/NRTI] WARN - ING: Lactic acidosis & severe hepatomegaly w/ steatosis reported w/ nucleoside analogs Uses: *HIV Infxn, chronic Hep B* Action: NRTI, ↓ HIV RT & Hep B viral polymerase, causes viral DNA chain termination Dose: HIV: Adults & Peds >16 y. 150 mg PO bid or 300 mg PO daily. Peds <16 y. 4 mg/kg PO bid. HBV: Adults. 100 mg/d PO. Peds 2–17 y. 3 mg/kg/d PO, 100 mg max; ↓ w/ renal impair Caution: [C, –] Disp: Tabs 100 mg (HBV) 150 mg, 300 mg; soln 5 mg/mL (HBV), 10 mg/mL SE: HA, pancreatitis, GI upset, lactic acidosis, peripheral neuropathy Interactions: ↑ Effects W/ cotrimoxazole, trimethoprim/sulfamethoxazole; ↑ risk of lactic acidosis W/ antiretrovirals, reverse transcriptase inhibitors Labs: ↑ LFTs; ↓ HMG, Hct, plts NIPE: Take w/ food to < GI upset Lamotrigine (Lamictal) [Anticonvulsant/Phenyltriazine] WARN - ING: Serious rashes requiring hospitalization & D/C of Rx reported; rash less frequent in adults Uses: *Partial Szs, tonic-clonic Szs, bipolar disorder, Lennox–Gastaut synd* Action: Phenyltriazine antiepileptic, ↓ glutamate, stabilize neuronal membrane Dose: Adults. Szs: Initial 50 mg/d PO, then 50 mg PO bid for 2 wk, maint 300–500 mg/d in 2 ÷ doses. Bipolar: Initial 25 mg/d PO, 50 mg PO daily for 2 wk, 100 mg PO daily for 1 wk, maint 200 mg/d. Peds. 0.6 mg/kg in 2 ÷ doses for wk 1 & 2, then 1.2 mg/kg for wk 3 & 4, maint 15 mg/kg/d (max 400 mg/d) 1–2 ÷ doses; ↓ in hepatic Dz or if w/ enzyme inducers or valproic acid Caution: [C, –] Interactions w/ other antiepileptics Disp: Tabs 25, 100, 150, 200 mg; chew tabs 2, 5, 25 mg SE: Photosens, HA, GI upset, dizziness, ataxia, rash (potentially life-threatening in children > adults) Notes: ? value of therapeutic monitoring In- teractions: ↑ Effects OF valproic acid; ↑ effects OF carbamazepine; ↓ effects W/ acetaminophen, OCPs, phenobarbital, phenytoin, primidone NIPE: ↑ Risk of photosensitivity—use sunscreen Lansoprazole (Prevacid, Prevacid IV) [Antisecretory/Proton- Pump Inhibitor] Uses: *Duodenal ulcers, prevent & Rx NSAID gastric ulcers, IV alternative for = 7 d w/ erosive esophagitis.* H. pylori Infxn, erosive esophagitis, & hypersecretory conditions, GERD Action: Proton pump inhibitor Dose: 15–30 mg/d PO; NSAID ulcer prevention 15 mg/d PO = 12 wk, NSAID ulcers 30 mg/d PO, × 8 wk; 30 mg IV daily = 7 d change to PO for 6–8 wk; ↓ in Lenalidomide 173 severe hepatic impair Caution: [B, ?/–] Disp: Caps 15, 30 mg; granules for susp 15, 30 mg, IV 30 mg; OD tabs 15, 30 mg SE: HA, fatigue Interactions: ↓ Effects W/ sucralfate; ↓ effects OF ampicillin, digoxin, iron, ketoconazole NIPE: Take ac; for IV provided in-line filter must be used Lanthanum Carbonate (Fosrenol) [Renal & GU Agent/Phos- phate Binder] Uses: *Hyperphosphatemia in renal disease * Action: Phos- phate binder Dose: 750–1500 mg PO daily ÷ doses, w/ or immediately after meal; –2 titrate every 2–3 wk based on PO 4 levels Caution: [C, ?/–] No data in GI disease Disp: Chew tabs 250, 500, 750, 1000 mg SE: N/V, graft occlusion, HA ↓ BP Labs: ↑ Serum Ca level; monitor serum phosphate levels NIPE: Use cautiously W/ GI disease; monitor for bone pain or deformity; chew tabs before swallowing; separate from meds that interact with antacids by 2 h Lapatinib (Tykerb) [Tyrosine Kinase Inhibitor] Uses: *Advanced breast CA w/ capecitabine w/ tumors that overexpress HER2 and have failed therapy w/ anthracycline, taxane, and trastuzumab* Action: Tyrosine kinase inhibitor Dose: Per protocol, 1250 mg PO days 1–21 w/ capecitabine 2000 mg/m2/d divided 2 doses/d day 1–14 Caution: [D; ?] avoid CYP3A4 inhibitors Contra: w/ phenothiazines Disp: Tabs 250 mg SE: N/V/D, anemia, ↓ plt, neutropenia, hand-foot synd, rash, ↓ LVEF; Interactions: ↑ Effects W/ potent CYP3A4 inhibitors (eg, ketoconazole), grapefruit; ↓ effects W/ potent CYP3A4 inducers (eg, carbamazepine) Labs:?↑ LFTs NIPE: Consider baseline LVEF and periodic ECG; take 1 h before or 1 h after a meal Latanoprost (Xalatan) [Glaucoma Agent] Uses: *Open angle glaucoma, ocular HTN* Action: Prostaglandin, ↑ outflow of aqueous humor Dose: 1 gtt eye(s) hs Caution: [C, ?] Disp: 0.005% soln SE: May darken light iri- des; blurred vision, ocular stinging, & itching Interactions: ↑ Risk OF precipitation if mixed w/ eye drops w/ thimerosal Leflunomide (Arava) [Antirheumatic DMARDs/Immuno- modulator] WARNING: PRG must be excluded prior to start of Rx Uses: *Active RA* Action: ↓ Pyrimidine synth Dose: Initial 100 mg/d PO for 3 d, then 10–20 mg/d Caution: [X, –] Contra: PRG Disp: Tabs 10, 20, 100 mg SE: D, Infxn, HTN, alopecia, rash, N, joint pain, hepatitis Interactions: ↑ Effects W/ rifampin; ↑ risk of hepatotox W/ hepatotoxic drugs, MRX; ↑ effects OF NSAIDs; ↓ effects W/ activated charcoal, cholestyramine Labs: ↑ LFTs; monitor LFTs during initial therapy NIPE: N PRG, breast-feeding, live virus vaccines Lenalidomide (Revlimid) [Immunomodulator] WARNING: Sig- nificant teratogen; patient must be enrolled in RevAssist risk reduction program Uses: *MDS* multiple myeloma Action: Thalidomide analog, immune modulator Dose: Adults. 10 mg PO daily; swallow whole w/ water Caution: [X, –] w/ renal impair Disp: Caps 5, 10, 15, 25 mg SE: D, pruritus, rash, fatigue, ↓ BM, thromboembolism, ↑ LFT Interactions: Monitor digoxin Labs: Monitor CBC; routine PRG tests required; ↑ LFTs, monitor for myelosuppression, thromboembolism, 174 Lepirudin hepatotox NIPE: Routine PRG tests required; Rx only in 1-mo increments; limited distribution network; males must use condom and not donate sperm; use contraception at least 4 wk beyond D/C Lepirudin (Refludan) [Anticoagulant/Thrombin Inhibitor] Uses: *HIT* Action: Direct thrombin inhibitor Dose: Bolus 0.4 mg/kg IV, then 0.15 mg/kg/h inf (↓ dose & inf rate if CrCl <60 mL/min) Caution: [B, ?/–] Hem- orrhagic event or severe HTN Contra: Active bleeding Disp: Inj 50 mg SE: Bleeding, anemia, hematoma Interactions: ↑ Risk of bleeding W/ antiplt drugs, cephalosporins, NSAIDs, thrombolytics, salicylates, feverfew, ginkgo biloba, ginger, valerian Labs: Adjust based on aPTT ratio, maintain aPTT 1.5–2.0 Letrozole (Femara) [Antineoplastic/Aromatase Inhibitor] Uses: *Advanced breast CA in postmenopausal* Action: Nonsteroidal aromatase inhibitor Dose: 2.5 mg/d PO Caution: [D, ?] Contra: PRG Disp: Tabs 2.5 mg SE: Anemia, N, hot flashes, arthralgia Interactions: ↑ Risk of interference W/ action of drug W/ estrogens and OCPs Labs: ↑ LFTs, cholesterol; monitor CBC, thyroid Fxn, lytes, LFT, & SCr Leucovorin (Wellcovorin) [Folic Acid Derivative/Vitamin] Uses: *OD of folic acid antagonist; megaloblastic anemia, augment 5-FU impaired MTX elimination* Action: Reduced folate source; circumvents action of folate reductase inhibitors (eg, MTX) Dose: Leucovorin rescue: 10 mg/m2 PO/IM/IV q6h; start w/in 24 h after dose or 15 mg PO/IM/IV q6h, 25 mg/dose max PO; Folate antagonist overdose (eg pemetrexed) 100 mg/m2 IM/IV ×1 then 50 mg/m2 IM/IV q6h × 8 d 100 mg/m2 ×1; 5-FU adjuvant Tx, colon CA per protocol; low dose: 20 mg/m2/d IV × 5 d w/ 5-FU 425 mg/m2/d IV × 5 d, repeat q4–5wk × 6; high dose: 500 mg/m2 IV qwk × 6, w/ 5-FU 500 mg/m2 IV qwk × 6 wk, repeat after 2 wk off × 4; Megaloblastic anemia: 1 mg IM/IV daily Caution: [C, ?/–] Contra: Perni- cious anemia Disp: Tabs 5, 10, 15, 25 mg; inj 50, 100, 200, 350, 500 SE: Allergic Rxn, N/V/D, fatigue Interactions: ↑ Effects OF fluorouracil; ↓ effects OF MTX, phenobarbital, phenytoin, primidone, trimethoprim/sulfamethoxazole Labs: Moni- tor Cr, methotrexate levels q24h w/ leucovorin rescue NIPE: ↑ Fluids to 3 L/d; do not use intrathecally/intraventrically Leuprolide (Lupron, Lupron DEPOT, Lupron DEPOT-Ped, Viadur, Eligard) [Antineoplastic/GnRH Analog] Uses: *Ad- vanced prostatic CA (all products except Depot-Ped), endometriosis (Lupron), uterine fibroids (Lupron), & precocious puberty (Lupron-Ped)* Action: LHRH agonist; paradoxically ↓ release of gonadotropin, resulting in ↓ pituitary go- nadotropins (↓ LH); in men ↓ testosterone Dose: Adults. PCa: Lupron DEPOT: 7.5 mg IM q28d or 22.5 mg IM q3mo or 30 mg IM q4mo; Eligard: 7.5 mg IM/SQ q28d or 22.5 mg IM q3mo or 30 mg IM/SQ q4mo; Eligard 45 mg SQ 6 mo; Viadur implant (PCa only); insert in inner upper arm w/ local anesthesia, replace q12mo. Endometriosis (Lupron DEPOT): 3.75 mg IM qmo × 6. Fibroids: 3.75 mg IM qmo × 3. Peds. CPP (Lupron-Ped): 50 μg/kg/d SQ inj; ↑ by 10 μg/kg/d until total down-regulation achieved. DEPOT: <25 kg: 7.5 mg IM q4wk. >25–37.5 kg: Levocabastine 175

11.25 mg IM q4wk. >37.5 kg: 15 mg IM q4wk Caution: [X, ?] w/ impending cord compression in PCa Contra: AUB, implant in women/peds; PRG Disp: Inj 5 mg/mL; Lupron DEPOT 3.75 (1 mo for fibroids, endometriosis); Lupron DEPOT for PCa: 7.5 mg (1 mo), 11.25 mg (3 mo), 22.5 (3 mo), 30 mg (4 mo); Eli- gard DEPOT for PCa: 7.5 mg (1 mo); 22.5 mg (3 mo), 30 mg (4 mo), 45 mg (6 mo); Viadur 65 mg 12-mo SQ implant, Lupron-Ped 7.5, 11.25, 15 mg SE: Hot flashes, gynecomastia, N/V, alopecia, anorexia, dizziness, HA, insomnia, paresthesias, depression exacerbation, peripheral edema, & bone pain (transient “flare Rxn” at 7–14 d after the 1st dose [LH/testosterone surge before suppression]) In- teractions: ↓ Effects W/ androgens, estrogens Labs: ↑ LFTs, BUN, Cr, uric acid, lipids, WBC; ↓ PT, PTT, plts NIPE: Nonsteroidal antiandrogen (eg, bicalutamide) may block flare in men W/ PCa Levalbuterol (Xopenex, Xopenex HFA) [Bronchodilator/ Beta2-Agonist] Uses: *Asthma (Rx & prevention of bronchospasm)*Ac- tion: Sympathomimetic bronchodilator; R-isomer of albuterol Dose: Adult. HFA 2 puffs q4–6h, 12 puffs/d max; 0.63–1.25 mg Neb q6–8h prn; Peds >4 y. HFA 2 puffs q4–6h, 12 puffs/d max; Peds 6–11> y. 0.31–0.63 mg neb q6–8h; Peds > 11 y. 0.63–1.25 mg neb q6–8h Caution: [C, ?] CAD, HTN, arrhythmias Contra: w/ phenothiazines, MAOI w/in 14 d Disp: Multidose inhaler (HFA) 45 μg/puff (15 g); Soln neb inhal 0.31, 0.63, 1.25 mg/3 mL SE: paradox bronchospasm, anaphylaxis, angioedema, tachycardia, nervousness,V Interactions: ↑ Effects W/ MAOIs, TCAs; ↑ risk of hypokalemia W/ loop & thiazide diuretics; ↓ effects W/ BBs; ↓ effects OF digoxin Labs: ↑ Serum glucose, ↓ serum K+ NIPE: May ↓ CV side effects compared w/ albuterol; do not mix w/ other nebs or dilute; use other inhalants 5 min after this drug Levetiracetam (Keppra) [Anticonvulsant/ Pyrrolidine Agent] Uses: *Partial onset Szs* Action: Unknown Dose: Adults and >16 y. 500 mg PO bid, may ↑ 3000 mg/d max; Peds. 4–15 y: 10–20 mg/kg/d ÷ in 2 doses, 60 mg/kg/d max (↓ in renal insuff) Caution: [C, ?/–] Elderly, w/ renal impair, psych disorders Contra: Component allergy Disp: Tabs 250, 500, 750, 1000 mg, Sol 100 mg/mL SE: Dizziness, somnolence, HA, hostility, aggression, myelosupp, impaired coordination Interactions: ↑ Effects W/ antihistamines, TCAs, benzodiazepines, narcotics, phenytoin; EtOH NIPE: May take w/ food; do not D/C abruptly Levobunolol (A-K Beta, Betagan) [Glaucoma Agent/Beta- Adrenergic Blocker] Uses: *Glaucoma* Action: β-Adrenergic blocker Dose: 1 gtt daily–bid Caution: [C, ?] Disp: Soln 0.25, 0.5% SE: Ocular stinging or burning Interactions: ↑ Effects W/ BBs; ↑ risk of hypotension & bradycardia W/ quinidine, verapamil; ↓ intraocular pressure W/ carbonic anhydrase inhibitors, epinephrine, pilocarpine NIPE: Night vision and acuity may be decreased; possible systemic effects if absorbed Levocabastine (Livostin) [Antihistamine] Uses: *Allergic seasonal conjunctivitis* Action: Antihistamine Dose: 1 gtt in eye(s) qid = 2 wk Caution: [C,+/–] Disp: 0.05% gtt SE: Ocular discomfort NIPE: N Insert soft contact lenses 176 Levofloxacin

Levofloxacin (Levaquin, Quixin & Iquix Ophthalmic) [An- tibiotic/Fluoroquinolone] Uses: *Lower resp tract Infxns, sinusitis, chronic bact prostatitis, pyelonephritis, UTI uncomp; skin Infxns; anthrax; topical for bacterial conjunctivitis* Action: Quinolone, ↓ DNA gyrase. Spectrum: Excel- lent gram(+) except MRSA & E. faecium; excellent gram(–) except S. maltophilia & Acinetobacter sp; poor anaerobic Dose: Usual 250–750 mg/d PO or IV; Sinusitis 750 mg PO/IV × 5 d; Prostatitis 500 mg PO/IV × 28 d; Uncomp UTI female 250 mg PO/IV × 3 d, if complicated × 10 d; CAP 750 mg/d for 5 d; Anthrax acute 500 mg PO/d × 60, start IV w/ other antibiotics; postexposure 500 mg PO daily × 60; ophth 1–2 gtt in eye(s) q2h while awake for 2 d, then q4h while awake for 5 d; ↓ in renal impair, avoid antacids if PO; oral sol 1 h before, 2 h after meals Caution: [C, –] w/ cation-containing products (eg, antacids) Contra: Quinolone sensitivity Disp: Tabs 250, 500, 750 mg; premixed IV 250, 500, 750 mg, inj 25 mg/mL; Leva-Pak 750 mg × 5 d; Sol: 25 mg/mL ophth soln 0.5% (Quixin), 1.5% (Iquix) SE: N/D, dizziness, rash, GI upset, photosens Interactions: ↑ Effects OF cyclosporine, digoxin, theophylline, warfarin, caffeine; ↑ risk of Szs W/ foscarnet, NSAIDs; ↑ risk of hyper- or hypoglycemia W/ hypoglycemic drugs; ↓ effects W/ antacids, antineoplastics, Ca, cimetidine, didanosine, famotidine, Fe, lansoprazole, Mg, nizatidine, omeprazole, phenytoin, ranitidine, NaHCO3, sucralfate, Zn NIPE: Risk of tendon rupture & tendonitis—D/C if pain or inflammation; ↑ fluids, use sunscreen, antacids 2 h before or after this drug Levonorgestrel (Plan B) [Progestin/Hormone] Uses: *Emer- gency contraceptive (“morning-after pill”)*; prevents PRG if taken <72 h after unprotected sex/contraceptive fails Action: Progestin, alters tubal transport, and endometrium Dose: Adult and Peds (post menarche females): 0.75 mg q12h × 2 Caution: [X, M] Contra: Known/suspected PRG, AUB Disp: Tab, 0.75 mg, 2 blister pack SE: N/V, abd pain, fatigue, HA, menstrual changes Interactions: ↓ Effects W/ barbiturates, carbamazepine, modafinil, phenobarbital, phenytoin, pioglitazone, rifabutin, rifampin, ritonavir, topiramate NIPE: Will not induce abortion; ↑ risk of ectopic PRG; OTC if >18 y, Rx if <18 y varies by state Levonorgestrel IUD (Mirena) [Progestin/Hormone] Uses: *Con- traception, long-term* Action: ?, May alter endometrium, thicken cervical mucus, interfere w/ sperm survival or capacitation Dose: Up to 5 y, insert w/in 7 d menses onset or immediately after 1st tri ab; wait 6 wk if postpartum; replace any time during menstrual cycle Caution: [C, ?] Contra: Disp: 52 mg IUD SE: Failed insertion, ectopic PRG, sepsis, PID, infertility, PRG comps w/ IUD left in place, abortion, embedment, ovarian cysts, perforation uterus/cervix, intestinal obst/perf, peritonitis NIPE: Counsel patient does not protect against STD/HIV; see insert for instructions Levorphanol (Levo-Dromoran) [C-II] [Narcotic Analgesic] Uses: *Moderate–severe pain; chronic pain* Action: Narcotic analgesic Dose: 2–4 mg PO PRN q6–8h; 1–2 mg IM/SQ PRN q6–8h; ↓ in hepatic impair Caution: [B/D (prolonged use/high doses at term), ?] Contra: Component allergy Disp: Tabs 2 mg; inj 2 mg/mL SE: Tachycardia, ↓ BP, drowsiness, GI upset, constipation, resp Lidocaine 177 depression, pruritus Interactions: ↑ CNS effects W/ antihistamines, cimetidine, CNS depressants, glutethimide, methocarbamol, EtOH, St. John’s wort Labs:↑ Amylase, lipase NIPE: ↑ Fluids & fiber, take w/ food Levothyroxine (Synthroid, Levoxyl, Others) [Thyroid Hor- mone] Uses: *Hypothyroidism, myxedema coma* Action: Supplement L- thyroxine Dose: Adults. Hypothyroid Initial, 12.5–50 μg/d PO; ↑ by 25–50 μg/d every mo; usual 100–200 μg/d. Myxedema: 200–500 μg IV, then 100–300 μg/d Peds. Hypothyroid: 0–3 mo: 10–15 μg/kg/24 h PO; 3–6 mo: 8–10 μg/kg/d PO; 6–12 mo: 6–8 μg/kg/d PO; 1–5 y: 5–6 μg/kg/d PO; 6–12 y: 4–5 μg/kd/d PO; >12 y: 2–3 μg/kd/d PO. Reduce dose by 50% if IV; titrate based on response & thyroid tests; dose can ↑ rapidly in young/middle-aged Caution: [A, +] Contra: Recent MI, uncorrected adrenal insuff Disp: Tabs 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 μg; inj 200, 500 μg SE: Insomnia, wt loss, alopecia, arrhythmia In- teractions: ↑ Effects OF anticoagulants, sympathomimetics, TCAs, warfarin; ↓ effects W/ antacids, BBs, carbamazepine, cholestyramine, estrogens, Fe salts, phenytoin, phenobarbital, rifampin, simethicone, sucralfate, ↓ effects OF digoxin, hypoglycemics, theophylline Labs: ↓ Thyroid function tests; drug alters thyroid uptake of radioactive I—D/C drug 4 wk before studies NIPE: N Switch brands due to different bioavailabilities; take w/ full glass of water (prevents choking) Lidocaine (Anestacon Topical, Xylocaine, others) [Antiar- rhythmic/Local Anesthetic] Uses: *Local anesthetic; Rx cardiac arrhythmias* Action: Anesthetic; class IB antiarrhythmic Dose: Adults. Antiarrhythmic, ET: 5 mg/kg; follow w/ 0.5 mg/kg in 10 min if effective. IV load: 1 mg/kg/dose bolus over 2–3 min; repeat in 5–10 min; 200–300 mg/h max; cont inf 20–50 μg/kg/min or 1–4 mg/min; Cardiac arrest from VF/VT: Initial: 1.0–1.5 mg/kg IV. Refractory VF: Additional 0.5–0.75 mg/kg IV push, repeat in 5–10 min, max total 3 mg/kg. ET: 2–4 mg/kg. Perfusing stable VT, wide complex tachycardia or ectopy: 1.0–1.5 mg/kg IV push; repeat 0.5–0.75 mg/kg q5–10min; max total 3 mg/kg; maint 1–4 mg/min (30–50 μg/min) (ECC 2005) Peds. Antiarrhythmic, ET, load: 1 mg/kg; repeat in 10–15 min 5 mg/kg max total, then IV inf 20–50 μg/kg/min. Top- ical: Apply max 3 mg/kg/dose. Local inj anesthetic: Max 4.5 mg/kg (Table 2) Cau- tion: [C, +] Contra: Do not use lidocaine w/ epi on digits, ears, or nose (risk of vasoconstriction & necrosis); heart block Disp: Inj local: 0.5, 1, 1.5, 2, 4, 10, 20%. Inj IV: 1% (10 mg/mL), 2% (20 mg/mL); admixture 4, 10, 20%. IV inf: 0.2%, 0.4%; cream 2%; gel 2, 2.5%; oint 2.5, 5%; Liq 2.5%; soln 2, 4%; viscous 2% SE: Dizziness, paresthesias, & convulsions associated w/ tox Notes: Systemic levels: steady state 6–12h: Therapeutic: 1.2–5 μg/mL; Toxic: >6 μg/mL; 1/2 life: 1.5 h Interactions: ↑ Effects W/ amprenavir, BBs, cimetidine; ↑ neuromuscular blockade W/ aminoglycosides, tubocuraine, pareira; ↑ cardiac depression W/ procainamide, phenytoin, propranolol, quinidine, tocainide; ↑ effects OF succinylcholine Labs: ↑ SCr, ↑ CPK for 48 h after IM inj NIPE: Oral spray/soln may impair swallowing; 2nd line to amiodarone in ECC; dilute ET dose 1–2 mL w/ NS; epi may be added for local anesthesia to ↑ effect & ↓ bleeding; for IV forms, ↓ W/ liver Dz or CHF 178 Lidocaine/Prilocaine

Lidocaine/Prilocaine (EMLA, LMX) [Topical Anesthetic] Uses: *Topical anesthetic*; adjunct to phlebotomy or dermal procedures Action: Topical anesthetic Dose: Adults. EMLA cream, anesthetic disc (1 g/10 cm2): Thick layer 2–2.5 g to intact skin, cover w/ occlusive dressing (eg, Tegaderm) for at least 1 h. Anesthetic disc: 1 g/10 cm2 for at least 1 h. Peds. Max dose: <3 mo or <5 kg: 1 g/10 cm2 for 1 h. 3–12 mo & >5 kg: 2 g/20 cm2 for 4 h. 1–6 y & >10 kg: 10 g/100 cm2 for 4 h. 7–12 y & >20 kg: 20 g/200 cm2 for 4 h Caution: [B, +] Methemoglobine- mia Contra: Use on mucous membranes, broken skin, eyes; allergy to amide-type anesthetics Disp: Cream 2.5% lidocaine/2.5% prilocaine; anesthetic disc (1 g) SE: Burning, stinging, methemoglobinemia; see Lidocaine NIPE: Low risk of systemic adverse effects; longer contact time ↑ effect Lidocaine/Tetracaine Transdermal (Synera) [Topical Anes- thetic] Uses: topical anesthetic; adjunct to phlebotomy or dermal procedures; Action: topical anesthetic; Dose: Adults & Children >3 yrs. Phlebotomy: apply to intact skin 20–30 min prior to venipuncture; Dermal procedures: apply to intact skin 30 min prior to procedure; Caution: (B, ±); Contra: pts w/ allergy to lidocaine/ tetracaine/ amide & ester type anesthetics; use on mucous membranes, broken skin, eyes; pts w/ PABA hypersensitivity; Disp: TD patch lidocaine 70 mg / tetracaine 70 mg; SE: erythema,blanching, edema, rash, burning, dizziness, HA, paresthesias; Notes: N use multiple patches simultaneously or sequentially; Inter- actions: ↑ systemic effects of Class I antiarrhythmic drugs (tocainide, mexiletine); ↑ systemic effects with other local anesthetics; NIPI: N cut patch/remove top cover-may cause thermal injury; low risk of systemic adverse effects. Lindane (Kwell) [OTC] [Scabicide/Pediculicide] Uses: *Head lice, crab lice, scabies* Action: Ectoparasiticide & ovicide Dose: Adults & Peds. Cream or lotion: Thin layer after bathing, leave for 8–12 h, pour on laundry. Sham- poo: Apply 30 mL, develop a lather w/ warm water for 4 min, comb out nits Cau- tion: [C, +/–] Contra: Open wounds, Sz disorder Disp: Lotion 1%; shampoo 1% SE: Arrhythmias, Szs, local irritation, GI upset Interactions: Oil-based hair creams ↑ drug absorption NIPE: Apply to dry hair/dry, cool skin; caution w/ overuse (may be absorbed); may repeat Rx in 7 d Linezolid (Zyvox) [Antibiotic/Oxazolidinones] Uses: *Infxns caused by gram(+) bacteria (including vancomycin-resistant Enterococcus, VRE), pneumonia, skin Infxns* Action: Unique, binds ribosomal bacterial RNA; bactericidal for streptococci, bacteriostatic for enterococci & staphylococci. Spectrum: Excellent gram(+) including VRE & MRSA Dose: Adults. 400–600 mg IV or PO q12h. Peds. 10 mg/kg IV or PO q8h (q12h in preterm neonates) Caution: [C, ?/–] w/ reversible MAOI, avoid foods w/ tyramine & cough/cold products w/ pseudoephedrine; w/ ↓ BM Disp: Inj 2 mg/mL; tabs 600 mg; susp 100 mg/5 mL SE: HTN, N/D, HA, insomnia, GI upset, ↓ BM, tongue discoloration Interactions: ↑ Risk of serotonin synd W/ SSRIs, sibutramine, trazodone, venlafaxine; ↑ HTN W/ amphetamines, dextromethorphan, dopamine, epinephrine, levodopa, MAOIs, Lithium Carbonate 179 meperidine, metaraminol, phenylephrine, phenylpropanolamine, pseudoephedrine, tyramine, ginseng, ephedra, ma huang, tyramine-containing foods; ↑ risk of bleeding W/ antiplts Labs: Follow weekly CBC NIPE: Take w/o regard to food, N tyramine- containing foods Liothyronine (Cytomel) [Thyroid Hormone] Uses: *Hypothy- roidism, goiter, myxedema coma, thyroid suppression therapy* Action: T3 replacement Dose: Adults. Initial 25 μg/24 h, titrate q1–2wk to response & TFT; maint of 25–100 μg/d PO. Myxedema coma: 25–50 μg IV. Peds. Initial 5 μg/24 h, titrate by 5-μg/24-h increments at 1–2-wk intervals; maint 20–75 μg/24 h PO daily; ↓ in elderly Caution: [A, +] Contra: Recent MI, uncorrected adrenal insuff, uncontrolled HTN Disp: Tabs 5, 25, 50 μg; inj 10 μg/mL SE: Alopecia, arrhythmias, CP, HA, sweating Interactions: ↑ Effects OF anticoagulants; ↓ effects W/ bile acid sequestrants, carbamazepine, estrogens, phenytoin, rifampin; ↓ effects OF hypoglycemics, theophylline Labs: Monitor TFT NIPE: Monitor cardiac status, take in AM Lisdexamfetamine (Vyvanse) [Stimulant] WARNING: Ampheta- mines have high abuse potential. Long-term use may cause dependency Uses: *ADHD* Action: Prodrug of dextroamphetamine Dose: Peds 6–12 y. 30 mg PO qAM, ↑ 20 mg/d each wk, max 70 mg/d Caution: [C, –] ↑ Sudden cardiac death, may exacerbate preexisting psych disorders Contra: Severe CV Dz, ↑ thyroid, BP, NAG, h/o drug abuse, w/in 14 d of MOI Disp: Caps 30, 50, 70 mg SE: N/V, dry mouth, pyrexia, ↓ appetite & wt, dizziness, HA, irritability, insomnia, rash Interactions: Risk of HTN crisis W/ MAOIs, furazolidone; ↑ effects W/ TCA, propoxyphene; ↑ effects OF meperidine, norepinephrine, phenobarbital, phenobarbital, TCA; ↓ effects W/ haloperidol, chlorpromazine, Li; ↓ effects OF adrenergic blockers, antihistamines, antihypertensives Labs: Monitor phenytoin levels; may interfere W/ urinary steroid tests NIPE: Adult approval pending; OK to open and dissolve in H2O Lisinopril (Prinivil, Zestril) [Antihypertensive/ACEI] Uses: *HTN, CHF, prevent DN & AMI* Action: ACE inhibitor Dose: 5–40 mg/24 h PO daily–bid. AMI: 5 mg w/in 24 h of MI, then 5 mg after 24 h, 10 mg after 48 h, then 10 mg/d; ↓ in renal insuff Caution: [D, –] Contra: ACE inhibitor sensitivity Disp: Tabs 2.5, 5, 10, 20, 30, 40 mg SE: Dizziness, HA, cough, ↓ BP, angioedema, ↑ K+ Interactions: ↑ Effects W/ α-blockers, diuretics ↑ risk of hyperkalemia W/ K- sparing diuretics, trimethoprim, salt substitutes; ↑ risk of cough W/ capsaicin; ↑ effects OF insulin, Li; ↓ effects W/ ASA, indomethacin, NSAIDs Labs: ↑ LFTs, serum K+, Cr, BUN NIPE: Maximum effect may take several weeks; To prevent DN, start when urinary microalbuminemia begins Lithium Carbonate (Eskalith, Lithobid, others) [Antipsy- chotic] Uses: *Manic episodes of bipolar Dz* Action: Effects shift toward in- traneuronal metabolism of catecholamines Dose: Adults. Bipolar, acute mania: 1800 mg/d PO in 3 ÷ doses in desired serum CNS. 1–15 mg/L. Bipolar maintenance: 900–1200/d PO in 2–3 ÷ dose Peds 2–12 y. 15–60 mg/kg/d in 3–4 ÷ doses; 180 Lodoxamide must titrate; ↓ in renal insuff, elderly Caution: [D, –] Many drug interactions Contra: Severe renal impair or CV Dz, lactation Disp: Caps 150, 300, 600 mg; tabs 300 mg; SR tabs 300, CR tabs 450 mg; syrup 300 mg/5 mL SE: Polyuria, polydipsia, nephrogenic DI, tremor; Na retention or diuretic use may ↑ tox; arrhythmias, dizziness Notes: Levels: Trough: Just before next dose: Therapeutic: 0.8–1.2 mEq/mL; Toxic: >2 mEq/mL; 1/2 life: 18–20h Interactions: ↑ Effects OF TCA; ↑ effects W/ ACEIs, bumetanide, carbamazepine, ethacrynic acid, fluoxetine, furosemide, methyldopa, NSAIDs, phenytoin, phenothiazines, probenecid, tetracyclines, thiazide diuretics, dandelion, juniper; ↓ effects W/ acetazolamide, antacids, mannitol, theophylline, urea, verapamil, caffeine Labs: ↑ Serum glucose, I-131 uptake, WBC; ↓ uric acid, ↑ T3, T4 NIPE: Several wk before full effects of med, fluid intake to 2–3 L/d Lodoxamide (Alomide) [Antihistamine] Uses: *Vernal conjunctivitis/keratitis* Action: Stabilizes mast cells Dose: Adults & Peds >2 y. 1–2 gtt in eye(s) qid = 3 mo Caution: [B, ?] Disp: Soln 0.1% SE: Ocular burning, stinging, HA NIPE: N children <2 y; N wear contact lens W/ drug Lomefloxacin (Maxaquin) [Antibiotic/Fluoroquinolone] Uses: *UTI, acute exacerbation of chronic bronchitis; prophylaxis in transurethral procedures* Action: Quinolone antibiotic; ↓ DNA gyrase. Spectrum: Good gram(–) including H. influenzae except S. maltophilia, Acinetobacter sp, & P. aeruginosa Dose: 400 mg/d PO; ↓ w/ renal insuff, avoid antacids Caution: [C, –] Interactions w/ cation-containing products Contra: Quinolone allergy, children <18 y,↑ QT interval, ↓K+ Disp: Tabs 400 mg SE: N/V/D, abd pain, photosens, Szs, HA, dizziness, tendon rupture, peripheral neuropathy, pseudomembranous colitis, anaphylaxis Interactions: ↑ Effects W/ cimetidine, probenecid; ↑ effects OF cyclosporine, warfarin, caffeine; ↓ effects W/ antacids Labs: ↑ LFTs, ↓ K+ NIPE: ↑ Risk of photosensitivity—use sunscreen, ↑ fluids to 2 L/d Loperamide (Imodium) [OTC] [Antidiarrheal] Uses: *D*Ac- tion: Slows intestinal motility Dose: Adults. Initial 4 mg PO, then 2 mg after each loose stool, up to 16 mg/d. Peds. 2–5 y, 13–20 kg: 1 mg PO tid. 6–8 y, 20–30 kg: 2 mg PO bid. 8–12 y, >30 kg: 2 mg PO tid Caution: [B, +] Not for acute D caused by Salmonella sp, Shigella sp, or C. difficile Contra: Pseudomembranous colitis, bloody D Disp: Caps 2 mg; tabs 2 mg; Liq 1 mg/5 mL (OTC) SE: Constipation, sedation, dizziness Interactions: ↑ Effects W/ antihistamines, CNS depressants, phenothiazines, TCAs, EtOH Lopinavir/Ritonavir (Kaletra) [Antiretroviral/Protease In- hibitor] Uses: *HIV Infxn* Action: Protease inhibitor Dose: Adults. Tx naïve: 2 tab PO daily or 1 tab PO bid; Tx experienced pt: 1 tab PO bid (↑ dose if w/ amprenavir, efavirenz, fosamprenavir, nelfinavir, nevirapine). Peds. 7–15 kg: 12/3 mg/kg PO bid. 15–40 kg: 10/2.5 mg/kg PO bid. >40 kg: Adult dose; w/ food Caution: [C, ?/–] Numerous interactions Contra: w/ drugs dependent on CYP3A/CYP2D6 (Table 11) Disp: (mg lopinavir/ritonavir) Tab 200/50, soln 400/100/5 mL SE: Avoid disulfiram (soln has EtOH), metronidazole; GI upset, asthenia, ↑ cholesterol/triglycerides, Lorazepam 181 pancreatitis; protease metabolic synd; Interactions: ↑ Effects W/ clarithromycin, erythromycin; ↑ effects OF amiodarone, amprenavir, azole antifungals, bepridil, cisapride, cyclosporine, CCBs, ergot alkaloids, flecainide, flurazepam, HMG-CoA reductase inhibitors, indinavir, lidocaine, meperidine, midazolam, pimozide, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, tacrolimus, terfenadine, triazolam, zolpidem; ↓ effects W/ barbiturates, carbamazepine, dexamethasone, didanosine, efavirenz, nevirapine, phenytoin, rifabutin, rifampin, St. John’s wort; ↓ effects OF OCPs, warfarin Labs:?↑ LFTs, cholesterol, triglycerides NIPE: Take w/ food, use barrier contraception Loracarbef (Lorabid) [Antibiotic/Cephalosporin-2nd Gener- ation] Uses: *Upper & lower resp tract, skin, urinary tract* Action: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Weaker than 1st-gen against gram(+), enhanced gram(–) Dose: Adults. 200–400 mg PO daily–bid. Peds. 7.5–15 mg/kg/d PO ÷ bid; on empty stomach; ↓ in severe renal insuff Caution: [B, +] Disp: Caps 200, 400 mg; susp 100, 200 mg/5 mL SE: D Interactions: ↑ Effects W/ probenecid; ↑ effects OF warfarin; ↑ nephrotox W/ aminoglycosides, furosemide NIPE: Take w/o food Loratadine (Claritin, Alavert) [Antihistamine] Uses: *Allergic rhinitis, chronic idiopathic urticaria* Action: Nonsedating antihistamine Dose: Adults. 10 mg/d PO Peds. 2–5 y: 5 mg PO daily. >6 y: Adult dose; on empty stomach; ↓ in hepatic insuff Caution: [B, +/–] Contra: Component allergy Disp: Tabs 10 mg (OTC); rapidly disintegrating Reditabs 10 mg; syrup 1 mg/mL SE: HA, somnolence, xerostomia Interactions: ↑ Effects W/ CNS depressants, erythromycin, ketoconazole, MAOIs, protease inhibitors, procarbazine, EtOH NIPE: Take w/o food Lorazepam (Ativan, Others) [C-IV] [Anxiolytic, Sedative/ Hypnotic/Benzodiazepine] Uses: *Anxiety & anxiety w/ depression; preop sedation; control status epilepticus*; EtOH withdrawal; antiemetic Action: Benzodiazepine; antianxiety agent Dose: Adults. Anxiety: 1–10 mg/d PO in 2–3 ÷ doses. Preop: 0.05 mg/kg to 4 mg max IM 2 h before surgery. Insomnia: 2–4 mg PO hs. Status epilepticus: 4 mg/dose IV PRN q10–15min; usual total dose 8 mg. Antiemetic: 0.5–2 mg IV or PO q4–6h PRN. EtOH withdrawal: 2–5 mg IV or 1–2 mg PO initial depending on severity; titrate Peds. Status epilepticus: 0.05 mg/kg/dose IV, repeat at 1–20 min intervals × 2 PRN. Antiemetic, 2–15 y: 0.05 mg/kg (to 2 mg/dose) prechemo; ↓ in elderly; do not administer IV >2 mg/min or 0.05 mg/kg/min Caution: [D, ?/–] Contra: Severe pain, severe ↓ BP, sleep apnea, NAG, allergy to propylene glycol or benzyl alcohol Disp: Tabs 0.5, 1, 2 mg; soln, PO conc 2 mg/mL; inj 2, 4 mg/mL SE: Sedation, ataxia, tachycardia, constipation, resp depression Interactions: ↑ Effects W/ cimetidine, disulfiram, probenecid, cal- endula, catnip, hops, lady’s slipper, passionflower, kava kava, valerian; ↑ effects OF phenytoin; ↑ CNS depression W/ anticonvulsants, antihistamines, CNS depressants, MAOIs, scopolamine, EtOH; ↓ effects W/ caffeine, tobacco; ↓ effects OF levodopa Labs: ↑ LFTs NIPE: N D/C abruptly; =10 min for effect if IV 182 Losartan

Losartan (Cozaar) [Antihypertensive/ARB] Uses: *HTN*, CHF, DN Action: Angiotensin II antagonist Dose: 25–50 mg PO daily–bid, max 100 mg; ↓ in elderly/hepatic impair Caution: [C (1st tri, D 2nd & 3rd tri), ?/–] Disp: Tabs 25, 50, 100 mg SE: ↓ BP in pts on diuretics; GI upset, angioedema Interactions: ↑ Risk of hyperkalemia W/ K-sparing diuretics, K supls, trimethoprim; ↑ effects OF Li; ↓ effects W/ diltiazem, fluconazole, phenobarbital, rifampin NIPE: N PRG, breast-feeding Lovastatin (Mevacor, Altocor) [Antilipemic/HMG-CoA Re- ductase Inhibitor] Uses: *Hypercholesterolemia* Action: HMG-CoA reductase inhibitor Dose: 20 mg/d PO w/ PM meal; may ↑ at 4-wk intervals to 80 mg/d max or 60 mg ER tab; take w/ meals Caution: [X, –] Avoid w/ grapefruit juice, gemfibrozil. Contra: Active liver Dz Disp: Tabs 10, 20, 40 mg; ER tabs 10, 20, 40, 60 mg SE: HA & GI intolerance common; promptly report any unexplained muscle pain, tenderness, or weakness (myopathy) Interactions: ↑ Effects W/ grapefruit juice; ↑ risk of severe myopathy W/ azole antifungals, cyclosporine, erythromycin, gemfibrozil, HMG-CoA inhibitors, niacin; ↑ effects OF warfarin; ↓ effects W/ isradipine, pectin Labs: ↑ LFTs; monitor LFT q12wk × 1 y, then q6mo NIPE: N PRG, take drug PM, periodic eye exams; maintain cholesterol-lowering diet Lubiprostone (Amitiza) [Laxative] Uses: *Chronic idiopathic constipation in adults* Action: Selective Cl channel activator Dose: Adults. 24 μg PO bid w/ food Contra: Mechanical GI obst Caution: [C,?/–] Severe D, severe renal or moderate-severe hepatic impair Disp: Gelcaps 24 μg SE: N, HA, D, GI distention, abd pain Labs: Monitor LFTs and BUN/Cr; requires (–) PRG test before Tx NIPE: Utilize contraception; periodically reassess drug need; not for chronic use; suspend drug if D; N breast-feeding Lutropin Alfa (Luveris) [Hormone] Uses: *Infertility* Action: Re- combinant LH Dose: 75 units SC w/ 75–150 units FSH, 2 separate inj max 14 d Caution: [X, ?/M] Contra: Primary ovarian failure, uncontrolled thyroid/adrenal dysfunction, intracranial lesion, AUB, hormone-dependent GU tumor, ovarian cyst, PRG Disp: Inj 75 units SE: HA, N, ovarian hyperstimulation synd, breast pain, ovarian cysts; ↑ risk of multiple births NIPE: Rotate inj sites; do not exceed 14 d duration unless signs of imminent follicular development Lymphocyte Immune Globulin [Antithymocyte Globulin, ATG] (Atgam) [Immunosuppressant] WARNING: Should only be used by health care provider experienced in immunosuppressive Tx or management of solid organ and/or BM transplant patients. Adequate lab and supportive medical resources must be readily available in the facility for patient management Uses: *Allograft rejection in transplant pts; aplastic anemia if not candidates for BMT* Action: ↓ Circulating T lymphocytes Dose: Adults. Prevent rejection: 15 mg/kg/d IV ×14 d, then qod ×7; initial w/in 24 h before/after transplant. Rx rejection: Same except use 10–15 mg/kg/d; max 28 doses in 21 d. Peds. 5–25 mg/kg/d IV. Caution: [C, ?] Contra: h/o Rxn to other equine γ-globulin preparation, leukopenia, thrombocytopenia Disp: Inj 50 mg/mL SE: D/C w/ severe thrombocytopenia/leukopenia; rash, fever, chills, ↓ BP, HA, ↑ K+ Notes: Test dose: 0.1 mL Magnesium Sulfate 183

1:1000 dilution in NS Interactions: ↑ Immunosuppression W/ azathioprine, corticosteroids, immunosuppressants Labs: ↑ LFTs NIPE: Risk of febrile Rxn Magaldrate (Riopan, Lowsium) [OTC] [Antacid/Aluminum & Magnesium Salt] Uses: *Hyperacidity associated w/ peptic ulcer, gastritis, & hiatal hernia* Action: Low-Na antacid Dose: 5–10 mL PO between meals & hs Caution: [B, ?] Contra: Ulcerative colitis, diverticulitis, ileostomy/ colostomy, renal insuff (Mg content) Disp: Susp (OTC) SE: GI upset Notes: <0.3 mg Na/tab or tsp Interactions: ↑ Effects OF levodopa, quinidine; ↓ effects OF allopurinol, anticoagulants, cefpodoxime, ciprofloxacin, clindamycin, digoxin, indomethacin, INH, ketoconazole, lincomycin, phenothiazine, quinolones, tetracyclines NIPE: N Other meds w/in 1–2 h Magnesium Citrate (various) [OTC] [Laxative/Magnesium Salt] Uses: *Vigorous bowel preparation*; constipation Action: Cathartic laxative Dose: Adults. 120–300 mL PO PRN. Peds. 0.5 mL/kg/dose, to 200 mL PO max; w/ a beverage Caution: [B, +] Contra: Severe renal Dz, heart block, N/V, rectal bleeding Disp: Effervescent soln (OTC) SE: Abd cramps, gas Interactions: ↓ Effects OF anticoagulants, digoxin, fluoroquinolones, ketoconazole, nitrofurantoin, phenothiazine, tetracyclines Labs: ↑ Mg2+, ↓ protein, Ca2+, K+ NIPE: N Other meds w/in 1–2 h Magnesium Hydroxide (Milk of Magnesia) [OTC] [Laxative/ Magnesium Salt] Uses: *Constipation*, hyperacidity, Mg replacement Action: NS Laxative Dose: Adults. Antacid: 5–15 mL PO PRN qid, 2–4 tab PO PRN QID; Laxative: 30–60 mL PO daily or in ÷ doses Peds. <2 y: 0.5 mL/kg/dose PO PRN; (follow dose w/ 8 oz of H2O Caution: [B, +] Contra: Renal insuff, intestinal obst, ileostomy/colostomy Disp: Chew tabs 311 mg; Liq 400, 800 mg/5 mL (OTC) SE: D, abd cramps Interactions: ↓ Effects OF chlordiazepoxide, dicumarol, digoxin, indomethacin, INH, quinolones, tetracyclines Labs: ↑ Mg2+, ↓ protein, Ca2+, K+ NIPE: N Other meds w/in 1–2 h Magnesium Oxide (Mag-Ox 400, others) [OTC] [Antacid, Magnesium Supplement/Magnesium Salt] Uses: *Replace low Mg levels* Action: Mg supl Dose: 400–800 mg/d ÷ daily–qid w/ full glass of H2O Caution: [B, +] Contra: Ulcerative colitis, diverticulitis, ileostomy/colostomy, heart block, renal insuff Disp: Caps 140 mg; tabs 400 mg (OTC) SE: D, N Interactions: ↓ Effects OF chlordiazepoxide, dicumarol, digoxin, indomethacin, INH, quinolones, tetracyclines Labs: ↑ Mg2+, ↓ protein, Ca2+, K+ NIPE: N Other meds w/in 1–2 h Magnesium Sulfate (Various) [Magnesium Supplement/ Magnesium Salt] Uses: *Replace low Mg2+; preeclampsia & premature labor, cardiac arrest; AMI*; refractory ↓ K+ & ↓ Ca2+ Action: Mg2+ supl Dose: Adults. 3 g PO q6h × 4 PRN; Supl: 1–2 g IM or IV; repeat PRN. Preeclampsia/premature labor: 4 g load then 1–4 g/h IV inf; Cardiac arrest: 1–2 g IV push (2–4 mL 50% soln) in 10 mL D5W AMI: Load 1–2 g in 50–100 mL D5W, over 5–60 min IV; then 0.5–1.0 g/h IV up to 24 h (ECC 2005) Peds. 25–50 mg/kg/dose IM or IV q4–6h for 3–4 doses; repeat PRN; ↓ dose w/ low urine output or renal insuff 184 Mannitol

Caution: [B, +] Contra: Heart block, renal failure Disp: Inj 10, 20, 40, 80, 125, 500 mg/mL; bulk powder SE: CNS depression, D, flushing, heart block Interac- tions: ↑ CNS depression W/ antidepressants, antipsychotics, anxiolytics, barbiturates, hypnotics, narcotics; EtOH; ↑ neuromuscular blockade W/ aminoglycosides, atracurium, gallamine, pancuronium, tubocurarine, vecuronium Labs: ↑ Mg2+; ↓ protein, Ca2+, K+ NIPE: Check for absent patellar reflexes Mannitol (Various) [Osmotic Diuretic] Uses: *Cerebral edema, ↑ intraocular pressure, renal impair, poisonings* Action: Osmotic diuretic Dose: Test dose: 0.2 g/kg/dose IV over 3–5 min; if no diuresis w/in 2 h, D/C. Oliguria: 50–100 g IV over 90 min; ↑ IOP: 0.5–2 g/kg IV over 30 min. Cerebral edema: 0.25–1.5 g/kg/dose IV >30 min. Caution: [C, ?] w/ CHF or volume overload Con- tra: Anuria, dehydration, HF, PE Disp: Inj 5, 10, 15, 20, 25% SE: May exacerbate CHF, N/V/D Interactions: ↑ Effects OF cardiac glycosides; ↓ effects OF barbiturates, imipramine, Li, salicylates Labs: ↑/↓ Electrolytes NIPE: Monitor for volume depletion Measles, Mumps, Rubella, and Varicella Virus Vaccine Live [MMRV] (Proquad) [Vaccine/Live Attenuated] Uses: *Vaccina- tion against measles, mumps, rubella, & varicella 12 mo–12 y or for 2nd dose of MMR* Action: Active immunization, live attenuated viruses Dose: 1 vial SQ inj Caution: [N/A] h/o cerebral injury or Szs (febrile Rxn) Contra: h/o anaphylaxis to neomycin, blood dyscrasia, lymphoma, leukemia, w/ immunosuppression, febrile illness, untreated TB Disp: Inj SE: Fever, inj site Rxn, rash NIPE: Allow 1 mo between inj & any other measles vaccine; limited avail; substitute MMR II or Varivax Mecasermin (Increlex) [Human IGF-1] Uses: *Growth failure in IGF-1 deficiency or HGH antibodies* Action: Human IGF-1 Dose: Peds. 0.04–0.08 mg/kg SQ bid; may ↑ by 0.04 mg/kg to 0.12 mg/kg; take w/in 20 min of meal Caution: [C,+/–] Disp: Vial 40 mg SE: HA, inj site Rxn, V, hypoglycemia Labs: Rapid dose ↑ may cause hypoglycemia; ↑?LFTs NIPE: Limited distribution Mechlorethamine (Mustargen) [Antineoplastic/Alkylating Agent] WARNING: Highly toxic, handle w/ care, limit use to experienced physicians Uses: *Hodgkin Dz & NHL, cutaneous T-cell lymphoma (mycosis fungoides), lung CA, CML, malignant pleural effusions*, & CLL Action: Alkylat- ing agent, bifunctional Dose: Per protocol; 0.4 mg/kg single dose or 0.1 mg/kg/d for 4 d; 6 mg/m2 1–2 × mo Caution: [D, ?] Contra: Known infectious Dz Disp: Inj 10 mg SE: ↓ BM, thrombosis, thrombophlebitis at site; tissue damage w/ extrav (Na thiosulfate used topically to Rx); N/V, skin rash, amenorrhea, sterility (especially in men), secondary leukemia if treated for Hodgkin Dz Interactions: ↑ Risk of blood dyscrasias W/ amphotericin B; ↑ risk of bleeding W/ anticoagulants, NSAIDs, plt inhibitors, salicylates; ↑ myelosuppression W/ antineoplastic drugs, radiation therapy; ↓ effects OF live virus vaccines Labs: ↑ Serum uric acid NIPE: Highly volatile; give w/in 30–60 min of prep; ↑ fluids to 2–3 L/d; N PRG, breast- feeding, vaccines, exposure to Infxn; ↑ risk of tinnitus Melphalan 185

Meclizine (Antivert) [Antiemetic/Antivertigo/Anticholinergic] Uses: *Motion sickness, vertigo* Action: Antiemetic, anticholinergic, & antihista- minic properties Dose: Adults & Peds >12 y. 12.5–100 mg PO tid–qid PRN Cau- tion: [B, ?] Disp: Tabs 12.5, 25, 50 mg; chew tabs 25 mg; caps 25, 30 mg (OTC) SE: Drowsiness, xerostomia, & blurred vision Interactions: ↑ Sedation W/ antihistamines, CNS depressants, neuroleptics, EtOH; ↑ anticholinergic effects W/ anticholinergics, atropine, disopyramide, haloperidol, phenothiazine, quinidine NIPE: Use prophylactically Medroxyprogesterone (Provera, Depo-Provera) [Antineo- plastic/Progestin] WARNING: May cause loss of bone density; associated w/ duration of use Uses: *Contraception; secondary amenorrhea, AUB caused by hormonal imbalance; endometrial CA* Action: Progestin supl Dose: Contraception: 150 mg IM q3mo depo or 104 mg SQ q3mo (depo SQ). Secondary amenorrhea: 5–10 mg/d PO for 5–10 d. AUB: 5–10 mg/d PO for 5–10 d beginning on the 16th or 21st d of menstrual cycle. Endometrial CA: 400–1000 mg/wk IM; ↓ in hepatic insuff Caution: [X, +] Contra: h/o thromboembolic disorders, hepatic Dz, PRG Disp: Tabs 2.5, 5, 10 mg; depo inj 150, 400 mg/mL; depo SQ inj 104 mg/10.65 mL SE: Breakthrough bleeding, spotting, altered menstrual flow, anorexia, edema, thromboembolic comps, depression, wt gain Interactions: ↓ Effects W/ aminoglutethimide, phenytoin, carbamazepine, phenobarbital, rifampin, rifabutin NIPE: Sunlight exposure may cause melasma; if GI upset take w/ food; perform breast exam & Pap smear before contraceptive therapy; obtain PRG test if last inj >3 mo Megestrol Acetate (Megace) [Antineoplastic/Progestin] Uses: *Breast/endometrial CAs; appetite stimulant in cachexia (CA & HIV)*Ac- tion: Hormone; progesterone analog Dose: CA: 40–320 mg/d PO in ÷ doses. Ap- petite: 800 mg/d PO ÷ dose Caution: [X, –] Thromboembolism Contra: PRG Disp: Tabs 20, 40 mg; soln 40 mg/mL; also available in 125 mg/mL (Megase ES) SE: DVT; edema, menstrual bleeding; photosens, insomnia, rash, ↓ BM Interac- tions: ↑ Effects OF warfarin Labs: ↑ LDH NIPE: ↑ Risk of photosensitivity—use sunscreen; do not D/C abruptly Meloxicam (Mobic) [Analgesic/Anti-inflammatory/NSAIDs] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Os- teoarthritis, RA, JRA* Action: NSAID w/ ↑ COX-2 activity Dose: Adult. 7.5–15 mg/d PO; Peds (>2 y): 0.125 mg/kg/d, max 7.5 mg; ↓ in renal insuff; take w/ food Caution: [C, D (3rd tri) ?/–] Peptic ulcer, NSAID, or ASA sensitivity Disp: Tabs 7.5, 15 mg; susp. 7.5 mg/5 mL SE: HA, dizziness, GI upset, GI bleeding, edema In- teractions: ↑ Effects OF ASA, anticoagulants, corticosteroids, Li, EtOH, tobacco; ↓ effects W/ cholestyramine; ↓ effects OF antihypertensives Labs: ↑ LFTs, BUN, Cr; ↓ HMG, WBCs, plat; NIPE: Take w/ food, may take several days for full effect Melphalan [L-PAM] (Alkeran) [Antineoplastic/Alkylating Agent] WARNING: Administered under the supervision of a qualified health care provider experienced in the use of chemotherapy; severe BM depression, 186 Memantine leukemogenic, & mutagenic Uses: *Multiple myeloma, ovarian CAs*, breast & testicular CA, melanoma; allogenic & ABMT (high dose) Action: Bifunctional alkylating agent Dose: (Per protocol) 6 mg/d or 0.15–0.25 mg/kg/d for 4–7 d, repeat 4–6-wk intervals, or 1 mg/kg × 1 q4–6wk; 0.15 mg/kg/d for 5 d q6wk. High- dose high-risk multiple myeloma: Single dose 140 mg/m2. ABMT: 140–240 mg/m2 IV; ↓ in renal insuff Caution: [D, ?] Contra: Allergy or resistance Disp: Tabs 2 mg; inj 50 mg SE: ↓ BM, secondary leukemia, alopecia, dermatitis, stomatitis, & pulm fibrosis; rare allergic Rxns Interactions: ↑ Risk OF nephrotox W/ cisplatin, cyclosporine; ↓ effects W/ cimetidine, interferon alfa Labs: ↓ HMG, RBCs, WBCs, plt NIPE: ↑ Fluids, N PRG, breast-feeding; take PO on empty stomach. Memantine (Namenda) [Anti-Alzheimer Agent/NMDA Re- ceptor Antagonist] Uses: *Moderate/severe Alzheimer Dz* Action: N- methyl-D-aspartate receptor antagonist Dose: Target 20 mg/d, start 5 mg/d, ↑ 5 mg/d to 20 mg/d, wait >1 wk before ↑ dose; use ÷ doses if >5mg/d Caution: [B, ?/–] Hepatic/mild–moderate renal impair Disp: Tabs 5, 10 mg, combo pack: 5 mg × 28 + 10 mg × 21; sol 2 mg/mL SE: Dizziness Interactions: ↑ Effects W/ amantadine, carbonic anhydrase inhibitors, dextromethorphan, ketamine, Na bicarbonate; ↑ effects W/ any drug, herb, food that alkalinizes urine Labs: Monitor BUN, SCr NIPE: Take w/o regard to food; EtOH ↑ adverse effects & ↓ effectiveness; renal clearance ↓ by alkaline urine (↓ 80% @ pH 8)Meningococcal conjugate vaccine (Menactra) [Vaccine/Live] Uses: *Immunize against N. meningitidis (meningo- coccus)* Action: Active immunization; diphtheria toxoid conjugate of N. meningitidis A, C, Y, W-135 Dose: Adults. 18–55 y: 0.5 mL IM × 1 Peds. 11–18 y: 0.5 mL IM × 1 Caution: [C, ?/–] Contra: Allergy to class/compound/latex; w/ acute Infxn Disp: Inj SE: Local inj site Rxns, HA, fatigue, arthralgia, Guillain–Barré Interac- tions: ↓ Effects W/ immunoglobulin if admin. w/in 1 mo NIPE: Pain & inflammation at inj site; keep epi (1:1000) available for anaphylactic/allergic Rxns; use polysaccharide >55 y Meningococcal Polysaccharide Vaccine (Menomune A/C/Y/ W-135) Uses: *Immunize against N. meningitidis* Action: Active immunization Dose: Adults & Peds >2 y: 0.5 mL SQ (not IM, intradermally, IV) may repeat 3–5 y if high risk Caution: [C, ?/–] Contra: Thimerosal/latex/sensitivity; w/ pertussis or typhoid vaccine, <2 y Disp: Inj SE: Local inj site Rxns, HA NIPE: Preferred in >55 y, conjugate vaccine (Menactra) in 11–55 y; active against serotypes A, C, Y, & W-135; not group B; keep epi (1:1000) available for Rxns Meperidine (Demerol) [C–II] [Opioid Analgesic] Uses: *Moderate–severe pain* Action: Narcotic analgesic Dose: Adults. 50–150 mg PO or IM/SQ q3–4h PRN. Peds. 1–1.5 mg/kg/dose PO or IM/SQ q3–4h PRN, up to 100 mg/dose; ↓ in elderly/renal impair Caution: [C/D (prolonged use or high dose at term), +] ↓ Sz threshold Contra: w/ MAOIs, renal failure Disp: Tabs 50, 100 mg; syrup 50 mg/5 mL; inj 10, 25, 50, 75, 100 mg/mL SE: Resp depression, Szs, sedation, constipation Interactions: ↑ Effects W/ antihistamines, barbiturates, cimetidine, Mesalamine 187

MAOIs, neuroleptics, selegiline, TCAs, St. John’s wort, EtOH; ↑ effects OF INH; ↓ effects W/ phenytoin Labs: ↑ Serum amylase, lipase NIPE: Analgesic effects potentiated w/ hydroxyzine; 75 mg IM = 10 mg morphine IM Meprobamate (Equinil, Miltown) [C-IV] [Antianxiety] Uses: *Short-term relief from anxiety* Action: Mild tranquilizer; antianxiety Dose: Adults. 400 mg PO tid–qid, max 2400 mg/d. Peds 6–12 y. 100–200 mg bid–tid; ↓ in renal/liver impair Caution: [D, +/–] Contra: NAG, porphyria, PRG Disp: Tabs 200, 400 mg SE: Drowsiness, syncope, tachycardia, edema Interactions: ↑ Effects W/ antihistamines, barbiturates, CNS depressants, narcotics, EtOH Mercaptopurine [6-MP] (Purinethol) [Antineoplastic/An- timetabolite] Uses: *Acute leukemias*, 2nd-line Rx of CML & NHL, maint ALL in children, immunosuppressant w/ autoimmune Dzs (Crohn Dz) Action: An- timetabolite, mimics hypoxanthine Dose: Adult. 80–100 mg/m2/d or 2.5–5 mg/kg/d; maint 1.5–2.5 mg/kg/d; w/ allopurinol use 67–75% ↓ dose of 6-MP (interference w/ xanthine oxidase metabolism) Peds. Per protocol ↓ w/ renal/hepatic insuff; on empty stomach Caution: [D, ?] Contra: Severe hepatic Dz, BM suppression, PRG Disp: Tabs 50 mg SE: Mild hematotox, mucositis, stomatitis, D rash, fever, eosinophilia, jaundice, hepatitis Interactions: ↑ Effects W/ allopurinol; ↑ risk of BM suppression W/ trimethoprim-sulfamethoxazole; ↓ effects OF warfarin Labs: False ↑ serum glucose, uric acid; ↑ LFTs; ↓ HMG, RBCs, WBC, plt NIPE: ↑ Fluid intake to 2–3 L/d, may take 4+ wk for improvement; handle properly; limit use to experienced health care providers Meropenem (Merrem) [Antibiotic/Carbapenem] Uses: *Intra- abd Infxns, bacterial meningitis* Action: Carbapenem; ↓ cell wall synth, a β-lactam. Spectrum: Excellent gram(+) (except MRSA & E. faecium); excellent gram(–) including extended-Spectrum β-lactamase producers; good anaerobic Dose: Adults. 1 to 2 g IV q8h. Peds. >3 mo, <50 kg 10–40 mg/kg IV q 8h; ↓ in renal insuff Cau- tion: [B, ?] Contra: β-lactam sensitivity Disp: Inj 1 g, 500 mg SE: Less Sz potential than imipenem; D, thrombocytopenia Interactions: ↑ Effects W/ probenecid Labs: ↑ LFTs, BUN, Cr, eosinophils ↓ HMG, Hct, WBCs, plt NIPE: Monitor for super Infxn; overuse ↑ bacterial resistance Mesalamine (Asacol, Lialda, Pentasa, Rowasa) [Anti-inflammatory/Salicylate] Uses: *Mild–moderate distal ulcerative colitis, proctosigmoiditis, proctitis* Action: Unknown; may inhibit prostaglandins Dose: Rectal: 60 mL qhs, retain 8 h (enema), 500 mg bid–tid or 1000 mg qhs (supp) PO: Cap: 1 g PO qid, Tab: 1.6–2.4 g/d ÷ doses (tid–qid); delayed release 2.4–4.8 g PO daily 8 wk max, do not cut/crush/chew w/ food; ↓ initial dose in elderly Caution: [B, M] Contra: Salicylate sensitivity Disp: Tabs 400 mg; caps 250, 500 mg; delayed release tab (Lialda) 1.2 g; supp 500, 1000 mg; rectal susp 4 g/60 mL SE: HA, malaise, abd pain, flatulence, rash, pancreatitis, pericarditis Interactions: ↓ Effect OF digoxin Labs: ↑ LFTs, amylase, lipase; NIPE: May discolor urine yellow-brown 188 Mesna

Mesna (Mesnex) [Uroprotectant/Antidote] Uses: *Prevent hemorrhagic cystitis due to ifosfamide or cyclophosphamide* Action: Antidote, reacts with acrolein and other metabolites to form stable compounds Dose: Per protocol; dose as % of ifosfamide or cyclophosphamide dose IV bolus: 20% (eg, 10–12 mg/kg) IV at 0, 4, 8 h, then 40% at 0, 1, 4, 7 h; IV inf: 20% prechemo, 50–100% w/ chemo, then 25–50% for 12 h following chemo; Oral: 20% IV dose at 0, 4, 8 h (mix with juice) Caution: [B; ?/–] Contra: Thiol sensitivity Disp: Inj 100 mg/mL; tabs 400 mg SE: ↓ BP, allergic Rxns, HA, GI upset, taste perversion Labs: ↑ LFTs NIPE: Hydration helps ↓ hemorrhagic cystitis; higher dose for BMT Mesoridazine (Serentil) [Antipsychotic/Phenothiazine] WARN - ING: Can prolong QT interval in dose-related fashion; torsades de pointes reported Uses: *Schizophrenia*, acute & chronic alcoholism, chronic brain synd Action: Phe- nothiazine antipsychotic Dose: Initial, 25–50 mg PO or IV tid; ↑ to 300–400 mg/d max Caution: [C, ?/–] Contra: Phenothiazine sensitivity, coadministration w/ drugs that cause QTc prolongation, CNS depression Disp: Tabs 10, 25, 50, 100 mg; PO conc 25 mg/mL; inj 25 mg/mL SE: Low incidence of EPS; ↓ BP, xerostomia, constipation, skin discoloration, tachycardia, lowered Sz threshold, blood dyscrasias, pigmentary retinopathy at high doses Interactions: ↑ Effects W/ antimalarials, BBs, chloroquine, TCAs, EtOH; ↑ effects OF antidepressants, nitrates, antihypertensives; ↑ QT interval W/ amiodarone, azole antifungals, disopyramide, fluoxetine, macrolides, paroxetine, procainamide, quinidine, quinolones, TCAs, verapamil; ↓ effects W/ attapulgite, barbiturates, caffeine, tobacco; ↓ effects of barbiturates, guanethidine, guanadrel, levodopa, Li, sympathomimetics Labs: False + PRG test; ↑ serum glucose, cholesterol; ↓ uric acid NIPE: Photosensitivity—use sunscreen Metaproterenol (Alupent, Metaprel) [Bronchodilator/Beta- Adrenergic Agonist] Uses: *Asthma & reversible bronchospasm* Action: Sympathomimetic bronchodilator Dose: Adults. Inhal: 1–3 inhal q3–4h, 12 inhal max/24 h; wait 2 min between inhal. PO: 20 mg q6–8h. Peds. Inhal: 0.5 mg/kg/dose, 15 mg/dose max inhaled q4–6h by neb or 1–2 puffs q4–6h. PO: 0.3–0.5 mg/kg/dose q6–8h Caution: [C, ?/–] Contra: Tachycardia, other arrhythmias Disp: Aerosol 0.65 mg/inhal; soln for inhal 0.4%, 0.6%; tabs 10, 20 mg; syrup 10 mg/5 mL SE: Nervousness, tremor, tachycardia, HTN Interactions: ↑ Effects W/ sympathomimetic drugs, xanthines; ↑ risk OF arrhythmias W/ cardiac glycosides, halothane, levodopa, theophylline, thyroid hormones; ↑ HTN W/ MAOIs; ↓ effects β W/ BBs NIPE: Separate additional aerosol use by 5 min; fewer 1 effects than isoproterenol & longer acting Metaxalone (Skelaxin) [Skeletal Muscle Relaxant] Uses: *Painful musculoskeletal conditions* Action: Centrally acting skeletal muscle relaxant Dose: 800 mg PO tid–qid Caution: [C, ?/–] Anemia Contra: Severe hepatic/renal impair Disp: Tabs 400, 800 mg SE: N/V, HA, drowsiness, hepatitis Interactions: ↑ Sedating effects W/ CNS depressants, EtOH Labs: False + urine glucose using Benedict test Methenamine 189

Metformin (Glucophage, Glucophage XR) [Hypoglycemic/ Biguanide] WARNING: Associated w/ lactic acidosis Uses: *Type 2 DM* Action: ↓ Hepatic glucose production & intestinal absorption of glucose; ↑ insulin sensitivity Dose: Adults. Initial: 500 mg PO bid; or 850 mg daily, may ↑ to 2550 mg/d max; take w/ AM & PM meals; can convert total daily dose to daily dose of XR Peds 10–16 y. 500 mg PO bid, ↑ 500 mg/wk to 2000 mg/d max in ÷ doses; do not use XR formulation in peds Caution: [B, +/–] avoid EtOH; hold dose before & 48 h after ionic contrast Contra: SCr >1.4 in females or >1.5 in males; hypoxemic conditions (eg acute CHF/sepsis) Disp: Tabs 500, 850, 1000 mg; XR tabs 500, 750, 1000 mg SE: Anorexia, N/V, rash, lactic acidosis (rare, but serious) Interactions: ↑ Effects W/ amiloride, cimetidine, digoxin, furosemide, MAOIs, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin; ↓ effects W/ corticosteroids, CCBs, diuretics, estrogens, INH, OCPs, phenothiazine, phenytoin, sympathomimetics, thyroid drugs, tobacco Labs: Monitor LFTs, N BUN/Cr, serum vitamin B12 NIPE: Take w/ food; dehydration, EtOH, before surgery Methadone (Dolophine) [C-II] [Opioid Analgesic] WARNING: Deaths, cardiac and respiratory have been reported during initiation and conversion of pain patients to methadone treatment from treatment with other opioids Uses: *Severe pain; detox w/ maint of narcotic addiction* Action: Narcotic analgesic Dose: Adults. 2.5–10 mg IM q3–8h or 5–15 mg PO q8h; titrate as needed Peds. 0.7 mg/kg/24 h PO or IM ÷ q8h; ↑ slowly to avoid resp depression; ↓ in renal impair Caution: [B/D (prolonged use/high doses at term), + (w/ doses =/> 20 mg/24 h)], severe liver Dz Disp: Tabs 5, 10, 40 mg; PO soln 5, 10 mg/5 mL; PO conc 10 mg/mL; inj 10 mg/mL SE: Resp depression, sedation, constipation, urinary retention, ↑ QT interval, arrhythmias Interactions: ↑ Effects W/ cimetidine, CNS depressants, protease inhibitors; EtOH; ↑ effects OF anticoagulants, EtOH, antihistamines, barbiturates, glutethimide, methocarbamol; ↓ effects W/ carbamazepine, nelfinavir, phenobarbital, phenytoin, primidone, rifampin, ritonavir Labs: ↑ Serum amylase, lipase, LFTs NIPE: Equianalgesic w/ parenteral morphine; longer 1/2-life Methenamine (Hiprex, Urex, Others) [Urinary Anti-infective] Uses: *Suppress/eliminate bacteriuria associated w/ chronic/recurrent UTI*Ac- tion: Converted to formaldehyde & ammonia in acidic urine; nonspecific bactericidal action Dose: Adults. Hippurate: 0.5–1 g bid. Mandelate: 1 g qid PO pc & hs Peds 6–12 y. Hippurate: 25–50 mg/kg/d PO ÷ bid. Mandelate: 50–75 mg/kg/d PO ÷ qid (take w/ food, ascorbic acid w/ adequate hydration) Caution: [C, +] Contra: Renal insuff, severe hepatic Dz, & severe dehydration; sulfonamide allergy Disp: Methenamine hippurate (Hiprex, Urex): Tabs 1 g. Methenamine mandelate: 500 mg, 1g EC tabs SE: Rash, GI upset, dysuria, ↑ LFTs Interac- tions: ↓ Effects W/ acetazolamide, antacids Labs: ↑ LFTs NIPE: ↑ Fluids to 2–3 L/d; take w/ food 190 Methimazole

Methimazole (Tapazole) [Antithyroid Agent] Uses: *Hyperthy- roidism, thyrotoxicosis*, prep for thyroid surgery or radiation Action: Blocks T3 & T4 formation Dose: Adults. Initial: 15–60 mg/d PO ÷ tid. Maint: 5–15 mg PO daily. Peds. Initial: 0.4–0.7 mg/kg/24 h PO ÷ tid. Maint: 1/3–2/3 of initial dose PO daily; w/ food Caution: [D, +/–] Contra: Breast-feeding Disp: Tabs 5, 10, 20 mg SE: GI upset, dizziness, blood dyscrasias Interactions: ↑ Effects OF digitalis glycosides, metoprolol, propranolol; ↓ effects OF anticoagulants, theophylline; ↓ effects W/ amiodarone Labs: ↑ LFTs, PT; follow clinically & w/ TFT NIPE: Take w/ food Methocarbamol (Robaxin) [Skeletal Muscle Relaxant/Cen- trally Acting] Uses: *Relief of discomfort associated w/ painful musculoskeletal conditions* Action: Centrally acting skeletal muscle relaxant Dose: Adults. 1.5 g PO qid for 2–3 d, then 1-g PO qid maint therapy; IV form rarely indicated. Peds. 15 mg/kg/dose IV, may repeat PRN (OK for tetanus only), max 1.8 g/m2/d for 3 d Caution: Sz disorders [C, +] Contra: MyG, renal impair Disp: Tabs 500, 750 mg; inj 100 mg/mL SE: Can discolor urine; drowsiness, GI upset Interac- tions: ↑ Effects W/ CNS depressant, EtOH Labs: ↑ Urine 5-HIAA NIPE: Monitor for blurred vision, orthostatic hypotension Methotrexate (Rheumatrex Dose Pack, Trexall) [Antineo- plastic, Antirheumatic (DMARDs), Immunosuppressant/An- timetabolite] WARNING: Administration only by experienced health care provider; do not use in women of childbearing age unless absolutely necessary (teratogenic); impaired elimination w/ impaired renal Fxn, ascites, pleural effusion; severe myelosuppression if used with NSAIDs; hepatotox; can induce lung disease; D and ulcerative stomatitis require D/C; lymphoma risk; may cause tumor lysis synd; can cause severe skin Rxn, opportunistic infns; with RT can ↑ risk of tissue necrosis Uses: *ALL, AML, leukemic meningitis, trophoblastic tumors (chorioepithelioma, choriocarcinoma, hydatidiform mole), breast, lung, head & neck CAs, Burkitt lymphoma, mycosis fungoides, osteosarcoma, Hodgkin Dz & NHL, psoriasis; RA* Action: ↓ Dihydrofolate reductase-mediated production of tetrahydrofolate Dose: CA: Per protocol. RA: 7.5 mg/wk PO 1/wk 1 or 2.5 mg q12h PO for 3 doses/wk; ↓ in renal/hepatic impair Caution: [D, –] Contra: Severe renal/hepatic impair, PRG/lactation Disp: Dose pack: 2.5 mg in 8, 12, 16, 20, or 24 doses; tabs 2.5 mg, 10 mg; inj 25 mg/mL SE: ↓ BM, N/V/D, anorexia, mucositis, hepatotox (transient & reversible; may progress to atrophy, necrosis, fibrosis, cirrhosis), rashes, dizziness, malaise, blurred vision, alopecia, photosens, renal failure, pneumonitis; rare pulm fibrosis; chemical arachnoiditis & HA w/ IT delivery Notes: Systemic levels Therapeutic: >0.01 μmole; Toxic >10 μmole over 24h In- teractions: ↑ Effects W/ chloramphenicol, cyclosporine, etretinate, NSAIDs, phenylbutazone, phenytoin, penicillin, probenecid, salicylates, sulfonamides, sulfonylureas, EtOH; ↑ effects OF cyclosporine, tetracycline, theophylline; ↑ effects W/ antimalarials, aminoglycosides, binding resins, cholestyramine, folic acid; Methylphenidate, transdermal 191

↓ effects OF digoxin Labs: Monitor CBC, LFTs, Cr, MTX levels & CXR NIPE: “High dose” >500 mg/m2 requires leucovorin rescue to ↓ tox; w/ intrathecal, use preservative-free/alcohol-free soln; ↑ risk OF photosensitivity—use sunscreen, ↑ fluids 2–3 L/d Methyldopa (Aldomet) [Antihypertensive/Centrally Acting Antiadrenergic] Uses: *HTN* Action: Centrally acting antihypertensive Dose: Adults. 250–500 mg PO bid–tid (max 2–3 g/d) or 250 mg–1 g IV q6–8h. Peds. 10 mg/kg/24 h PO in 2–3 ÷ doses (max 40 mg/kg/24 h ÷ q6–12h) or 5–10 mg/kg/dose IV q6–8h to total dose of 20–40 mg/kg/24 h; ↓ in renal insuff/elderly Caution: [B (PO), C (IV), +] Contra: Liver Dz; MAOIs Disp: Tabs 125, 250, 500 mg; inj 50 mg/mL SE: Discolors urine; initial transient sedation/drowsiness frequent, edema, hemolytic anemia, hepatic disorders Interactions: ↑ Effects W/ anesthetics, diuretics, levodopa, Li, methotrimeprazine, thioxanthenes, vasodilators, verapamil; ↑ effects OF haloperidol, Li, tolbutamide; ↓ effects W/ amphetamines, Fe, phenothiazine, TCAs; ↓ effects OF ephedrine Labs: ↑ BUN, Cr; ↓ LFTs, HMG, RBC, WBC, plt NIPE: After 1–2 mo tolerance may develop Methylergonovine (Methergine) [Oxytocic/Ergot Alkaloid] Uses: *Postpartum bleeding (uterine subinvolution)* Action: Ergotamine derivative Dose: 0.2 mg IM after placental delivery, may repeat 2–4-h intervals or 0.2–0.4 mg PO q6–12h for 2–7 d Caution: [C, ?] Contra: HTN, PRG Disp: In- jectable 0.2 mg/mL; tabs 0.2 mg SE: HTN, N/V Interactions: ↑ Vasoconstriction W/ ergot alkaloids, sympathomimetics, tobacco NIPE: N Smoking; give IV over >1 min w/ BP monitoring Methylphenidate, Oral (Concerta, Ritalin, Ritalin SR, Oth- ers) [CII] [CNS Stimulant/Piperidine Derivative] WARNING: w/ h/o of drug or alcohol dependence; chronic use can lead to dependence or psychotic behavior; observe closely during withdrawal of drug Uses: *ADHD, narcolepsy* depression Action: CNS stimulant Dose: Adults. Narcolepsy: 10 mg PO 2–3 ×/d, 60 mg/d max. Depression: 2.5 mg qAM; ↑ slowly, 20 mg/d max; use regular release only Peds. Based on product; initial total daily dose of 15–20 mg; 90 mg/d max; administer once (ER/SR) to bid (regular) Caution: [C,+/–] h/o alcoholism or drug abuse; separate from MAOIs by 14 d Disp: Tabs 5, 10, 20 mg; Tabs SR (Ritalin SR) 20 mg; ER tabs (Concerta) 18, 27, 36, 54 mg SE: CV, CNS stimulation Interactions: ↑ Risk of hypertensive crisis W/ MAOIs; ↑ effects OF anticonvulsants, anticoagulants, TCA, SSRIs; ↓ effects OF guanethidine, antihypertensives Labs: Monitor CBC, plts NIPE: Titrate dose; take 30–45 min before meals; do not chew or crush; concerta “ghost tablet” may appear in stool; see insert to convert to ER dose; see also transdermal methylphenidate; abuse and diversion concerns; D/C if Sz or agitation occurs Methylphenidate, transdermal (Daytrana) [CII] [CNS Stimu- lant] WARNING: w/ h/o of drug or alcohol dependence; chronic use can lead to dependence or psychotic behavior; observe closely during withdrawal of drug 192 Methylprednisolone

Uses: *ADHD in children 6–12 y* Action: CNS stimulant Dose: Peds. Apply to hip in AM (2 h before desired effect), remove 9 h later Caution: [C,+/–] sensitization may preclude subsequent use of oral forms; abuse and diversion concerns Disp: Patches 10, 15, 20, 30 mg SE: Local Rxns, stimulation Interactions: ↑ Effects OF oral anticoagulants, phenobarbital, phenytoin, primidone, SSRIs, TCAs; ↑ risk OF hypertensive crisis W/ MAOIs; caution W/ pressor drugs NIPE: Titrate dose in weekly increments; effects last several hours following removal; rotate application sites; N expose patches to direct external sources of heat; eval BP, HR at baseline and periodically Methylprednisolone (Solu-Medrol) [See Steroids and Table 3] Metoclopramide (Reglan, Clopra, Octamide) [Antiemetic/ Dopamine Antagonist] Uses: *Diabetic gastroparesis, symptomatic GERD; chemo N/V, facilitate small-bowel intubation & UGI radiologic eval* stimulate gut in prolonged postop ileus Action: ↑ UGI motility; blocks dopamine in chemoreceptor trigger zone Dose: Adults. Gastroparesis: 10 mg PO 30 min ac & hs for 2–8 wk PRN, or same dose IV for 10 d, then PO. Reflux: 10–15 mg PO 30 min ac & hs. Antiemetic: 1–3 mg/kg/dose IV 30 min before chemo, then q2h × 2 doses, then q3h × 3 doses. Peds. Reflux: 0.1 mg/kg/dose PO qid. Antiemetic: 1–2 mg/kg/dose IV as adults Caution: [B, –] Drugs w/ extrapyramidal ADRs Contra: Sz disorders, GI obst Disp: Tabs 5, 10 mg; syrup 5 mg/5 mL; inj 5 mg/mL SE: Dystonic Rxns common w/ high doses, (Rx w/ IV diphenhydramine); restlessness, D, drowsiness Interactions: ↑ Risk OF serotonin synd W/ sertraline, venlafaxine; ↑ effects OF acetaminophen, ASA, CNS depressants, cyclosporine, levodopa, Li, succinylcholine, tetracyclines, EtOH; ↓ effects W/ anticholinergics, narcotics; ↓ effects OF cimetidine, digoxin Labs: ↑ Serum ALT, AST, amylase NIPE: Monitor for extrapyramidal effects Metolazone (Mykrox, Zaroxolyn) [Antihypertensive/Thi- azide Diuretic] Uses: *Mild–moderate essential HTN & edema of renal Dz or cardiac failure* Action: Thiazide-like diuretic; ↓ distal tubule Na reabsorption Dose: Adult. HTN: 2.5–5 mg/d PO (Zaroxolyn), 0.5–1 mg/d PO (Mykrox) Edema: 2.5–20 mg/d PO. Peds. 0.2–0.4 mg/kg/d PO ÷ q12h–daily Caution: [D, +] Contra: Thiazide/sulfonamide sensitivity, anuria Disp: Tabs: Mykrox (rapid acting) 0.5 mg, Zaroxolyn 2.5, 5, 10 mg SE: Monitor fluid/lytes; dizziness, ↓ BP, tachycardia, CP, photosens Notes: Mykrox & Zaroxolyn not bioequivalent Interactions: ↑ Effects W/ antihypertensives, barbiturates, narcotics, nitrates, EtOH, food; ↑ effects OF digoxin, Li; ↑ hyperglycemia W/ BBs, diazoxide; ↑ hypokalemia W/ amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin; ↓ effects W/ cholestyramine, colestipol, hypoglycemics, insulin, NSAIDs, salicylates; ↓ effects OF methenamine Labs: ↑ Serum and urine glucose, serum cholesterol, triglycerides, uric acid; ↓ K+, NA+, Mg+ NIPE: ↑ Risk of photosensitivity—use sunscreen; ↑ risk of gout; monitor electrolytes Mexiletine 193

Metoprolol (Lopressor, Toprol XL) [Antihypertensive/BB] WARNING: Do not acutely stop therapy as marked worsening of angina can result Uses: *HTN, angina, AMI, CHF* Action: β-adrenergic receptor blocker Dose: Adult. Angina: 50–200 mg PO bid max 400 mg/d HTN: 50–200 mg PO bid max 450 mg/d. AMI: 5 mg IV q2min × 3 doses, then 50 mg PO q6h × 48 h, then 100 mg PO bid. CHF: 12–25 mg/d PO × 2 wk, ↑ at 2-wk intervals to 200 mg/max, use low dose in pts w/ greatest severity; 5 mg slow IV q5min, total 15 mg (ECC 2005); ↓ in hepatic failure; take w/ meals Caution: [C, +] Uncompensated CHF, bradycardia, heart block Contra: Arrhythmia w/ tachycardia Disp: Tabs 25, 50, 100 mg; ER tabs 25, 50, 100, 200 mg; inj 1 mg/mL SE: Drowsiness, insomnia, ED, bradycardia, bronchospasm Interactions: ↑ Effects W/ cimetidine, dihydropyridine, diltiazem, fluoxetine, hydralazine, methimazole, OCPs, propylthiouracil, quinidine, quinolones; ↑ effects OF hydralazine; ↑ bradycardia W/ digoxin, dipyridamole, verapamil; ↓ effects W/ barbiturates, NSAIDs, rifampin; ↓ effects OF isoproterenol, theophylline Labs: ↑ BUN, SCr, LFTs, uric acid NIPE: Take w/ food, N D/C abruptly—withdraw over 2 wk Metronidazole (Flagyl, MetroGel) [Antibacterial, Antiproto- zoals] WARNING: Carcinogenic in rats Uses: *Bone/joint, endocarditis, intra-abd, meningitis, & skin Infxns; amebiasis; trichomoniasis; bacterial vaginosis; PID; giardiasis; pseudomembranous colitis (C. difficile)* Action: Interferes w/ DNA synth. Spectrum: Excellent anaerobic C. difficile, also H. pylori in combo therapy Dose: Adults. Anaerobic Infxns: 500 mg IV q6–8h. Amebic dysentery: 750 mg/d PO for 5–10 d. Trichomoniasis: 250 mg PO tid for 7 d or 2 g PO × 1. C. difficile: 500 mg PO or IV q8h for 7–10 d (PO preferred; IV only if pt NPO). Vaginosis: 1 applicatorful intravag bid or 500 mg PO bid for 7 d. Acne rosacea/skin: Apply bid. Peds. 30 mg/ kg PO/IV/d divided q6H, 4 g/d max÷. Amebic dysentery: 35–50 mg/kg/24 h PO in 3 ÷ doses for 5–10 d;, Rx 7–10 d for C. difficile; ↓ in hepatic impair Caution: [B, M] Avoid EtOH Contra: 1st tri of PRG Disp: Tabs 250, 500 mg; XR tabs 750 mg; caps 375 mg; IV 500 mg/100mL; topical lotion & gel 0.75%; intravag gel 0.75% (5 g/applicator 37.5 mg in 70-g tube), cream 1% SE: Disulfiram-like Rxn; dizziness, HA, GI upset, anorexia, urine discoloration Interactions: ↑ Effects W/ cimetidine; ↑ effects OF carbamazepine, fluorouracil, Li, warfarin; ↓ effects W/ barbiturates, cholestyramine, colestipol, phenytoin Labs: May cause ↓/zero values for LFTs, triglycerides, glucose NIPE: Take w/ food, possible metallic taste; for trichomoniasis, Rx pt’s partner; no aerobic bacteria activity; use in combo w/ serious mixed Infxns Mexiletine (Mexitil) [Antiarrhythmic/Lidocaine Analogue] WARNING: Mortality risks noted for flecainide and/or enceinte (type 1 antiar- rhythmias). Reserve for use in patients with life-threatening Ventricular Arrhythmias Uses: *Suppress symptomatic ventricular arrhythmias*; diabetic neuropathy Ac- tion: Class IB antiarrhythmic (Table 10) Dose: Adults. 200–300 mg PO q8h; 1200 mg/d max. Peds. 2.5–5 mg/kg PO q8h; w/ food or antacids Caution: [C, +] May 194 Miconazole worsen severe arrhythmias; interacts w/ hepatic inducers & suppressors (dosage changes) Contra: Cardiogenic shock or 2nd-/3rd-degree AV block w/o pacemaker Disp: Caps 150, 200, 250 mg SE: Lightheadedness, dizziness, anxiety, incoordination, GI upset, ataxia, hepatic damage, blood dyscrasias; Interactions: ↑ Effects W/ fluvoxamine, quinidine, caffeine; ↑ effects OF theophylline; ↓ effects W/ atropine, hydantoins, phenytoin, phenobarbital, rifampin, tobacco Labs: ↑ LFTs; ↓ plts; monitor LFTs & CBC NIPE: Take w/ food < GI upset Miconazole (Monistat, others) [Antifungal] Uses: *Candidal In- fxns, dermatomycoses (various tinea forms)* Action: Fungicide; alters fungal membrane permeability Dose: Apply to area bid for 2–4 wk. Intravag: 1 applicatorful or supp hs for 3 d (4% or 200 mg) or 7 d (2% or 100 mg) Caution: [C, ?] Azole sensitivity Disp: Topical cream 2%; lotion 2%; powder 2%; spray 2%; vag supp 100, 200 mg; vag cream 2%, 4% [OTC] SE: Vag burning Interactions: ↑ Ef- fects OF anticoagulants, cisapride, loratadine, phenytoin, quinidine; ↓ effects W/ amphotericin B; ↓ effects OF amphotericin B Labs: ↑ Protein NIPE: Antagonistic to amphotericin B in vivo Miconazole/Zinc Oxide/Petrolatum (Vusion) [Antifungal] Uses: *Candidal diaper rash* Action: Combo antifungal Dose: Peds > 4 wk. Apply at each diaper change × 7d Caution: [C, ?] Contra: None Disp: Micona- zole/zinc oxide/petrolatum oint 0.25%/81.35%/15% SE: None NIPE: Keep diaper dry Midazolam (Hypnovel, Versed) [C-IV] [Sedative/Benzodi- azepine] Uses: *Preop sedation, conscious sedation for short procedures & mechanically ventilated pts, induction of general anesthesia* Action: Short-acting benzodiazepine Dose: Adults. 1–5 mg IV or IM; titrate to effect. Peds. Preop: >6 mo 0.25–1 mg/kg PO, 20 mg max. Conscious sedation: 0.08 mg/kg × 1. >6 mo 0.1–0.15 mg/kg IM × 1 max 10 mg. General anesthesia: 0.025 –0.1 mg/kg IV q2min for 1–3 doses PRN to induce anesthesia (↓ in elderly, w/ narcotics or CNS depressants) Caution: [D, +/–] w/ CYP3A4 substrate (Table 11), multiple drug interactions Contra: NAG; w/ amprenavir, nelfinavir, ritonavir Disp: Inj 1, 5 mg/mL; syrup 2 mg/mL SE: Resp depression; ↓ BP w/ conscious sedation, N Interactions: ↑ Effects W/ azole antifungals, antihistamines, cimetidine, CCBs, CNS depressants, erythromycin, INH, phenytoin, protease inhibitors, grapefruit juice, EtOH; ↓ effects W/ rifampin, tobacco; ↓ effects OF levodopa NIPE: Monitor for resp depression; reversal w/ flumazenil Mifepristone [RU 486] (Mifeprex) [Abortifacient/Synthetic Steroid] WARNING: Pt counseling & information required; associated w/ fatal Infxns & bleeding Uses: *Terminate intrauterine PRGs of <49 d* Action: An- tiprogestin; ↑ prostaglandins, results in uterine contraction Dose: Administered w/ 3 office visits: day 1, three 200-mg tabs PO; day 3 if no abortion, two 200-mg tabs PO; on or about day 14, verify termination of PRG Caution: [X, –] Contra: Minoxidil 195

Anticoagulation therapy, bleeding disorders Disp: Tabs 200 mg SE: Abd pain & 1–2 wk of uterine bleeding Interactions: ↑ Effects W/ azole antifungals, erythromycin, grapefruit juice; ↓ effects W/ carbamazepine, dexamethasone, phenytoin, phenobarbital, rifampin, St. John’s wort NIPE: Give under supervision of health care provider only Miglitol (Glyset) [Hypoglycemic/Alpha-Glucosidase In- hibitor] Uses: *Type 2 DM* Action: γ-Glucosidase inhibitor; delays digestion of carbohydrates Dose: Initial 25 mg PO tid; maint 50–100 mg tid (w/ 1st bite of each meal) Caution: [B, –] Contra: DKA, obst/inflammatory GI disorders; SCr >2 Disp: Tabs 25, 50, 100 mg SE: Flatulence, D, abd pain Interac- tions: ↑ Effects W/ celery, coriander, juniper berries, ginseng, garlic; ↓ effects w/ INH, niacin, intestinal absorbents, amylase, pancreatin ; ↓ effects OF digoxin, propranolol, ranitidine Labs: N Use w/ SCr >2 mg/dL NIPE: Use alone or w/ sulfonylureas Milrinone (Primacor) [Vasodilator/Bipyridine Phosphodi- esterase Inhibitor] Uses: *CHF*, Ca antagonist intoxication Action: Phosphodiesterase inhibitor, + inotrope & vasodilator; little chronotropic activity Dose: 50 μg/kg, then 0.375–0.75 μg/kg/min IV inf; ↓ in renal impair Caution: [C, ?] Contra: Allergy to drug; w/ amrinone Disp: Inj 200 μg/mL, 1 mg/mL SE: Arrhythmias, ↓ BP, HA Interactions: ↑ Hypotension W/ nesiritide NIPE: Monitor fluids, lytes, BP, HR Mineral Oil [OTC] [Emollient Laxative] Uses: *Constipation* Action: Lubricant laxative Dose: Adults. 15–45 mL PO PRN. Peds >6 y. 5–25 mL PO qd Caution: [C, ?] N/V, difficulty swallowing, bedridden pts Contra: Colostomy/ileostomy, appendicitis, diverticulitis, UC Disp: Liq [OTC] SE: Lipid pneumonia Interactions: ↑ Effects W/ stool softeners; ↓ effects OF cardiac glycosides, OCPs, sulfonamides, vitamins, warfarin NIPE: Rectal incontinence Minocycline (Solodyn) [Antibiotic/Tetracycline] Uses: *Acne* Action: Tetracycline, bacteriostatic Dose: Adult and Peds >12 y 1 mg/kg PO daily × 12wk; w/ food to ↓ irritation Caution: [C, ?] assoc w/ pseudomembranous colitis; w/ renal impair Contra: Allergy, women of childbearing potential Disp: Tabs ER 45, 90, 135 SE: D, HA, fever, rash, joint pain, fatigue, dizziness Interactions: ↑ Effects OF digoxin, oral anticoagulants; ↑ risk of nephrotox W/ methoxyflurane; ↓ effects W/ antacids, cholestyramine, colestipol, laxatives, cimetidine, Fe products; ↓ effects OF hormonal contraceptives Labs: ↑ LFTs, BUN; ↓ HMG, plts, WBCs NIPE: Do not cut/crush/chew; keep away from children; risk of photosensitivity—use sunscreen; may take W/ food to < GI upset Minoxidil (Loniten, Rogaine) [Antihypertensive/Vasodila- tor, Topical Hair Growth] Uses: *Severe HTN; male & female pattern baldness* Action: Peripheral vasodilator; stimulates vertex hair growth Dose: Adults. HTN: 2.5–80 mg PO ÷ daily–bid, max 100 mg/d. Topical: (Baldness) 196 Mirtazapine

Apply bid to area. Peds. 0.2–1 mg/kg/24 h ÷ PO q12–24h, max 50 mg/d; ↓ PO in elderly Caution: [C, +] Contra: Pheochromocytoma, component allergy Disp: Tabs 2.5, 5, 10 mg; topical soln (Rogaine) 2%, 5% SE: Pericardial effusion & volume overload w/ PO use; edema, ECG changes, wt gain Interactions: ↑ Hypoten- sion W/ guanethidine Labs: ↑ Alkaline phosphatase, BUN, Cr; ↓ HMG, Hct NIPE: Hypertrichosis w/ chronic use; take PO drug w/ food to < GI upset Mirtazapine (Remeron, Remeron SolTab) [Tetracyclic Anti- depressant] WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression* Action: α 2-antagonist antidepressant Dose: 15 mg PO hs, up to 45 mg/d hs Caution: [C, ?] w/ clonidine, CNS depressant use; CYP1A2, CYP3A4 inducers/inhibitors Contra: MAOIs w/in 14 d Disp: Tabs 15, 30, 45 mg; rapid dissolving tabs 15, 30, 45 mg SE: Somnolence, ↑ cholesterol, constipation, xerostomia, wt gain, agranulocytosis Interactions: ↑ Effects W/ CNS depressants, fluvoxamine; ↑ risk OF HTN crisis W/ MAOIs Labs: ↑ ALT, cholesterol, triglycerides NIPE: Handle rapid tabs with dry hands, do not cut or chew; Do not ↑ dose at intervals of less than 1–2 wk Misoprostol (Cytotec) [Mucosal Protective Agent/Prosta- glandin] WARNING: Use in PRG can cause abortion, premature birth, or birth defects; do not use to decrease ulcer risk in women of childbearing age Uses: *Prevent NSAID-induced gastric ulcers*; induce labor (cervical ripening); incomplete & therapeutic abortion Action: Prostaglandin (PGE-1), w/ antisecretory & mucosal protective properties; induces uterine contractions Dose: Ulcer prevention: 200 μg PO qid w/ meals; in females, start 2nd or 3rd day of next nl menstrual period; 25–50 μg for induction of labor (term); 400 μg on day 3 of mifepristone for PRG termination; take w/ food Caution: [X, –] Contra: PRG, component allergy Disp: Tabs 100, 200 μg SE: Can cause miscarriage w/ potentially dangerous bleeding; HA, GI common (D, abd pain, constipation) Interac- tions: ↑ HA & GI symptoms W/ phenylbutazone Mitomycin (Mutamycin) [Antineoplastic/Alkylating Agent] WARNING: Administer only by physician experienced in chemotherapy; myelosuppressive; can induce hemolytic uremic synd with irreversible renal failure Uses: *Stomach, pancreas*, breast, colon CA; squamous cell carcinoma of the anus; non-small-cell lung, head & neck, cervical; bladder CA (intravesically) Action: Alkylating agent; may generate oxygen-free radicals w/ DNA strand breaks Dose: Per protocol; 20 mg/m2 q6–8wk or 10 mg/m2 in combo w/ other myelosuppressive drugs; bladder CA 20–40 mg in 40 mL NS via a urethral catheter once/wk × 8 wk, followed by monthly × 12 mo for 1 y; ↓ in renal/hepatic impair Caution: [D, –] Contra: Thrombocytopenia, leukopenia, coagulation disorders, SCr >1.7 mg/dL Disp: Inj 5, 20, 40 mg SE: ↓ BM, (persists 3–8 wk after, may be cumulative; minimize w/ lifetime dose <50–60 mg/m2), N/V, anorexia, stomatitis, renal tox; microangiopathic hemolytic anemia w/ progressive renal failure (like hemolytic–uremic synd); Molindone 197 venoocclusive liver Dz, interstitial pneumonia, alopecia; extrav Rxns; contact dermatitis Interactions: ↑ Bronchospasm W/ vinca alkaloids; ↑ BM suppression W/ antineoplastics Mitoxantrone (Novantrone) [Antineoplastic/Antibiotic] WARNING: Administer only by health care provider experienced in chemotherapy; except for acute leukemia, do not use w/ ANC count of <1500 cells/mm3; severe neutropenia can result in Infxn, follow CBC; cardiotoxic (CHF), secondary AML reported Uses: *AML (w/ cytarabine), ALL, CML, PCA, MS, Lung CA* breast CA, & NHL Action: DNA-intercalating agent; ↓ DNA synth by interacting with topoisomerase II Dose: Per protocol; ↓ w/ hepatic impair, leukopenia, thrombocytopenia Caution: [D, –] Reports of secondary AML (monitor CBC) Contra: PRG, significant ↓ in LVEF Disp: Inj 2 mg/mL SE: ↓ BM, N/V, stomatitis, alopecia (infrequent), cardiotox, urine discoloration Interactions: ↑ BM suppression W/ antineoplastics; ↓ effects OF live virus vaccines Labs: ↑ AST, ALT, uric acid NIPE: ↑ Fluids to 2–3 L/d, maintain hydration N vaccines, Infxn; cardiac monitoring prior to each dose Modafinil (Provigil) [Analeptic/CNS Stimulant] Uses: * Im- prove wakefulness in pts w/ narcolepsy & excess daytime sleepiness* Action: Al- ters dopamine & norepinephrine release, ↓ GABA-mediated neurotransmission Dose: 200 mg PO q AM; ↓ dose 50% w/elderly/hepatic impair Caution: [C,?/–] CV Dz; Contra: Component allergy Disp: Tabs 100, 200 mg SE: HA, N, D, paresthesias, rhinitis, agitation Interactions: ↑ Effects OF CNS stimulants, diazepam, phenytoin, propranolol, TCAs, warfarin; ↓ effect OF cyclosporine, OCPs, theophylline Labs: ↑ Glucose, AST, GTT NIPE: Take w/o regard to food; monitor BP; use barrier contraception Moexipril (Univasc) [Antihypertensive/ACEI] Uses: *HTN, post- MI,* DN Action: ACE inhibitor Dose: 7.5–30 mg in 1–2 ÷ doses 1 h ac ↓ in renal impair Caution: [C (1st tri, D 2nd & 3rd tri), ?] Contra: ACE inhibitor sensitivity Disp: Tabs 7.5, 15 mg SE: ↓ BP, edema, angioedema, HA, dizziness, cough Inter- actions: ↑ Effects W/ diuretics, antihypertensives, EtOH, probenecid, garlic; ↑ effects OF insulin, Li; ↑ risk OF hyperkalemia with K supl, K-sparing diuretics; ↓ effects W/ antacids, ASA, NSAIDS, ephedra, yohimbe, ginseng Labs: ↑ BUN, Cr, K+; ↓ Na+ NIPE: May alter sense of taste, may cause cough, N salt substitutes, N PRG, use barrier contraception Molindone (Moban) [Antipsychotic] Uses: *Psychotic disorders* Action: Piperazine phenothiazine Dose: Adults. 50–75 mg/d PO, ↑ to max of 225 mg/d at 3–4 d intervals if necessary. Peds. 3–5 y: 1–2.5 mg/d PO in 4 ÷ doses. 5–12 y: 0.5–1.0 mg/kg/d in 4 ÷ doses Caution: [C, ?] NAG Contra: Drug/EtOH CNS depression Disp: Tabs 5, 10, 25, 50 mg SE: ↓ BP, tachycardia, arrhythmias, EPS, Szs, constipation, xerostomia, blurred vision Interactions: ↑ Effects W/ antihypertensives; ↑ hyperkalemia W/ K-sparing diuretics, K supls, salt substitutes, trimethoprim; ↑ effects OF insulin, Li; ↓ effects W/ ASA, NSAIDs Labs: ↑ Serum 198 Montelukast

K+, BUN, Cr; monitor lipid profile, fasting glucose, HgB A1-c NIPE: Take w/o food; monitor for persistent cough Montelukast (Singulair) [Bronchodilator/Leukotriene Re- ceptor Antagonist] Uses: *Prophylaxis & Rx of chronic asthma, seasonal allergic rhinitis* Action: Leukotriene receptor antagonist Dose: Asthma: Adults & Peds >15 y. 10 mg/d PO taken in PM. Peds. 2–5 y: 4 mg/d PO taken in PM. 6–14 y: 5 mg/d PO in PM. Caution: [B, M] Contra: Component allergy Disp: Tabs 10 mg; chew tabs 4, 5 mg; granules 4 mg/packet SE: HA, dizziness, fatigue, rash, GI upset, Churg–Strauss synd Interactions: ↑↓Effects W/ phenobarbital, rifampin Labs: ↑ AST, ALT NIPE: Not for acute asthma Morphine (Avinza XR, Duramorph, Infumorph, MS Contin, Kadian SR, Oramorph SR, Infumorph, Roxanol) [C-II] [Analgesic/Opioid Agonist] Uses: *Relief of severe pain* AMI Ac- tion: Narcotic analgesic Dose: Adults. PO: 5–30 mg q4h PRN; SR tabs 15–60 mg q8–12h (do not chew/crush). IV/IM: 2.5–15 mg q2–6h; supp 10–30 mg q4h. IT: (Duramorph, Infumorph): Per protocol Peds. >6 mo 0.1–0.2 mg/kg/dose IM/IV q2–4h PRN to 15 mg/dose max; 0.2–0.5 mg/kg PO q4–6h PRN; 0.3–0.6 mg/kg SR tabs PO q12h; 2–4 mg IV (over 1–5 min) every 5–30 min (ECC 2005) Caution: [B (D w/ prolonged use/high doses at term), +/–] Contra: Severe asthma, resp depression, GI obst Disp: Immediate-release tabs 10, 15, 30 mg; MS Contin CR tabs 15, 30, 60, 100, 200 mg; Oramorph SR CR tabs 15, 30, 60, 100 mg; Kadian SR caps 20, 30, 50, 60, 80, 100 mg; Avinza XR caps 30, 60, 90, 120 mg; soln 10, 20, 100 mg/5 mL; supp 5, 10, 20, 30 mg; inj 2, 4, 5, 8, 10, 15, 25, 50 mg/mL; Du- ramorph/Astramorph inj 0.5, 1 mg/mL; Infumorph 10, 25 mg/mL, supp 5, 10, 20, 30 mg SE: Narcotic SE (resp depression, sedation, constipation, N/V, pruritus), granulomas w/ IT Interactions: ↑ Effects W/ cimetidine, CNS depressants, dextroamphetamine, TCAs, EtOH, kava kava, valerian, St. John’s wort; ↑ effects OF warfarin; ↑ risk OF HTN crisis W/ MAOIs; ↓ effects W/ opioids, phenothiazines Labs: ↑ Serum amylase, lipase NIPE: May require scheduled dosing to relieve severe chronic pain; do not crush/chew SR/CR forms Morphine liposomal (DepoDur) [Analgesic/Opioid Agonist] Uses: *Long-lasting epidural analgesia* Action: ER morphine analgesia Dose: 10–20 mg lumbar epidural inj (C-section 10 mg after cord clamped) Caution: [C,+/–] elderly, biliary Dz (sphincter of Oddi spasm) Contra: Ileus, resp depression, asthma, obst airway, suspected/known head injury ↑ ICP, allergy to morphine. Disp: Inj 10 mg/mL SE: Hypoxia, resp depression, ↓ BP, retention, N/V, constipation, flatulence, pruritus, pyrexia, anemia, HA, dizziness, tachycardia, insomnia, ileus NIPE: Effect =48 h; not for IT/IV/IM Moxifloxacin (Avelox, Vigamox ophthalmic) [Antibiotic/ Fluoroquinolone] Uses: *Acute sinusitis & bronchitis, skin/soft tissue In- fxns, conjunctivitis, & community-acquired pneumonia* Action: 4th-gen quinolone; ↓ DNA gyrase. Spectrum: Excellent gram(+) except MRSA & E. faecium; good gram(–) except P. aeruginosa, S. maltophilia, & Acinetobacter sp; good anaerobic Mycophenolate Mofetil 199 coverage Dose: 400 mg/d PO/IV; avoid cation products, antacids. Ophth: 1 gtt tid ×7d; take PO 4 h before or 8 h after antacids Caution: [C, ?/–] Quinolone sensitivity; interactions w/ Mg-, Ca-, Al-, Fe-containing products & class IA & III antiarrhythmic agents Contra: Quinolone/component sensitivity Disp: Tabs 400 mg, inj, ophth 0.5% SE: Dizziness, N, QT prolongation, Szs, photosens, tendon rupture Interactions: ↑ Ef- fects W/ probenecid; ↑ effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin; ↓ effects W/ antacids, didanosine, Fe salts, Mg, ↑ sucralfate, NaHCO3, Zn Labs: LFTs, BUN, SCr, amylase, PT, triglycerides, cholesterol; ↓ HMG, Hct NIPE: N Give to children <18 y; ↑ fluids to 2–3 L/d Multivitamins, Oral [OTC] (Table 13) Mupirocin (Bactroban) [Topical Anti-infective] Uses: *Impetigo; eradicate MRSA in nasal carriers* Action: ↓ Bacterial protein synth Dose: Topical: Apply small amount to area 3 ×/d × 5–14 d. Nasal: Apply bid in nostrils × 5d Cau- tion: [B, ?] Contra: Do not use w/ other nasal products Disp: Oint 2%; cream 2% SE: Local irritation, rash. Interactions: ↓ Bacterial action W/ chloramphenicol NIPE: Instruct patient to contact health care provider if no improvement in 3–5 d Muromonab-CD3 (Orthoclone OKT3) [Immunosuppressant/ Monoclonal Antibody] WARNING: Can cause anaphylaxis; monitor fluid status Uses: *Acute rejection following organ transplantation* Action: Murine Ab, blocks T-cell Fxn Dose: Per protocol Adults. 5 mg/d IV for 10–14 d. Peds. 0.1 mg/kg/d IV for 10–14 d Caution: [C, ?/–] w/ h/o Szs, PRG, uncontrolled HTN, Contra: Murine sensitivity, fluid overload Disp: Inj 5 mg/5 mL SE: Anaphylaxis, pulm edema, fever/chills w/ 1st dose (premedicate w/ steroid/ APAP/antihistamine) Interactions: ↑ Effects W/ immunosuppressives; ↑ effects OF live virus vaccines; ↑ risk OF CNS effects & encephalopathy W/ indomethacin Labs: ↑ BUN, Cr NIPE: N Immunizations, exposure to Infxn; monitor during inf; use 0.22-μg filter Mycophenolic Acid (Myfortic) [Immunosuppressant/My- cophenolic Acid Derivative] WARNING: ↑ Risk of Infxns, possible development of lymphoproliferative disorders Uses: *Prevent rejection after renal transplant* Action: Cytostatic to lymphocytes Dose: Adults. 720 mg PO bid. Peds. BSA 400 mg/m2 max 720 mg bid; ↓ in renal insuff/neutropenia; take on empty stomach Caution: [C, ?/–] Contra: Component allergy Disp: DR tabs 180, 360 mg SE: N/V/D, pain, fever, HA, Infxn, HTN, anemia, leukopenia, edema Interactions: ↓ OF phenytoin, theophylline; ↓ W/ antacids, cholestyramine, Fe Labs: ↑ Cholesterol; monitor CBC NIPE: If GI distress-take w/ food; avoid crowds & people w/ Infxns Mycophenolate Mofetil (CellCept) [Immunosuppressant/ Mycophenolic Acid Derivative] WARNING: ↑ Risk of Infxns, possible development of lymphoma Uses: *Prevent organ rejection after transplant* Action: ↓ Immunologically mediated inflammatory responses Dose: Adults. 1 g PO bid; Peds. BSA 1.2–1.5 m2: 750 mg PO bid; BSA >1.5 m2: 1 g PO bid; may taper up to 600 mg/m2 PO bid; used w/ steroids & cyclosporine; ↓ in renal insuff or neutropenia. IV: Inf over >2 h. PO: Take on empty stomach, do not open capsules Caution: [C, ?/–] Contra: Component allergy; IV use in polysorbate 80 allergy 200 Nabilone

Disp: Caps 250, 500 mg; susp 200 mg/mL, inj 500 mg SE: N/V/D, pain, fever, HA, Infxn, HTN, anemia, leukopenia, edema Interactions: ↑ Effects W/ acyclovir, ganciclovir, probenecid; ↑ effects OF acyclovir, ganciclovir; ↓ effects W/ antacids, cholestyramine, cyclosporine, Fe, food; ↓ effects OF OCPs, phenytoin, theophylline Labs: ↑ Cholesterol; monitor CBC NIPE: Use barrier contraception during and 6 wk after drug therapy; N exposure to Infxn; take w/o food Nabilone (Cesamet) [CII] [Synthetic Cannabinoid] WARN- ING: Psychotomimetic Rxns, may persist for 72 h following D/C; caregivers should be present during initial use or dosage modification; patients should not operate heavy machinery; avoid alcohol, sedatives, hypnotics, other psychoactive substances Uses: *Refractory chemo-induced emesis* Action: Synthetic cannabinoid Dose: Adults. 1–2 mg PO bid 1–3 h before chemo, 6 mg/d max; may continue for 48 h beyond final chemo dose Caution: [C,?/–] Elderly, HTN, HF, underlying psychiatric illness, substance abuse; high protein binding w/ 1st-pass metabolism may lead to drug interactions Disp: Caps 1 mg SE: Drowsiness, vertigo, xerostomia, euphoria, ataxia, HA, difficulty concentrating, tachycardia, ↓ BP Interactions: ↑ CNS depression W/ benzodiazepines, barbiturates, CNS depressants, EtOH; ↑ effects W/ opioids; ↑ effects OF opioids; cross-tolerance W/ opioids NIPE: May require initial dose evening before chemo; Rx only quantity for single cycle Nabumetone (Relafen) [Analgesic, Anti-inflammatory, An- tipyretic/NSAID] WARNING: May ↑risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose: 1000–2000 mg/d ÷ daily–bid w/ food Caution: [C (D 3rd tri), +] severe hepatic Dz Contra: Peptic ulcer, NSAID sensitivity, after CABG surgery Disp: Tabs 500, 750 mg SE: Dizziness, rash, GI upset, edema, peptic ulcer Interactions: ↑ Effects W/ aminoglycosides; ↑ effects OF anticoagulants, hypoglycemics, Li, MTX, thrombolytics; ↑ GI effects W/ ASA, corticosteroids, K supls, NSAIDs, EtOH; ↓ effects OF antihypertensives, diuretics NIPE: Photosensitivity—use sunscreen Nadolol (Corgard) [Antihypertensive, Antianginal/BB] Uses: *HTN & angina* migraine prophylaxis Action: Competitively blocks β β β ↑ -adrenergic receptors ( 1, 2) Dose: 40–80 mg/d; to 240 mg/d (angina) or 320 mg/d (HTN) at 3–7 d intervals; ↓ in renal insuff & elderly Caution: [C (1st tri; D if 2nd or 3rd tri), +] Contra: Uncompensated CHF, shock, heart block, asthma Disp: Tabs 20, 40, 80, 120, 160 mg SE: Nightmares, paresthesias, ↓ BP, bradycardia, fatigue Interactions: ↑ Effects W/ antihypertensives, diuretics, nitrates, EtOH; ↑ effects OF aminophylline, lidocaine; ↑ risk of HTN W/ clonidine, ephedrine, epinephrine, MAOIs, phenylephrine, pseudoephedrine; ↑ bradycardia W/ digitalis glycosides, ephedrine, epinephrine, phenylephrine, pseudoephedrine; ↓ effects W/ ampicillin, antacids, clonidine, NSAIDs, thyroid meds; ↓ effects OF glucagon, theophylline NIPE: May ↑ cold sensitivity; N D/C abruptly Nafcillin (Nallpen) [Antibiotic/Penicillinase-Resistant Penicillin] Uses: *Infxns due to susceptible strains of Staphylococcus sp & Naphazoline 201

Streptococcus sp * Action: Bactericidal β-lactamase-resistant penicillin; ↓ cell wall synth. Spectrum: Good gram(+) except MRSA and Enterococcus sp, no gram (–), poor anaerobe Dose: Adults. 1–2 g IV q4–6h. Peds. 50–200 mg/kg/d ÷ q4–6h Cau- tion: [B, ?] PCN allergy Disp: Inj powder l, 2 g SE: Interstitial nephritis, D, fever, N Interactions: ↑ Effects OF MTX; ↓ effects W/ chloramphenicol, macrolides, tetracyclines; ↓ effects OF cyclosporine, OCPs, tacrolimus, warfarin Labs: ↑ Serum protein; no adjustments for renal Fxn NIPE: Aminoglycosides not compatible, risk of drug inactivation w/ fruit juice/carbonated drinks; monitor for super Infxn Naftifine (Naftin) [Antifungal/Antibiotic] Uses: *Tinea pedis, cruris, & corporis* Action: Allylamine antifungal, ↓ cell membrane ergosterol synth Dose: Apply daily (cream) or bid (gel) Caution: [B, ?] Contra: Component sensitivity Disp: 1% cream; gel SE: Local irritation Nalbuphine (Nubain) [Analgesic/Narcotic Agonist-Antago- nist] Uses: *Moderate–severe pain; preop & obstetric analgesia* Action: Nar- cotic agonist–antagonist; ↓ ascending pain pathways Dose: Adults. 10–20 mg IM or IV q3–6h PRN; max of 160 mg/d; 20 mg max 1 × dose Peds. 0.2 mg/kg IV or IM, 20 mg max; ↓ in hepatic insuff Caution: [B (D w/ prolonged/high doses at term), ?] Contra: Sulfite sensitivity Disp: Inj 10, 20 mg/mL SE: CNS depression, drowsiness; caution w/ opiate use, ↓ BP Interactions: ↑ CNS depression W/ cimetidine, CNS depressants; EtOH ↑ effects OF digitoxin, phenytoin, rifampin Labs: ↑ Serum amylase, lipase NIPE: Monitor for resp depression Naloxone (Narcan) [Antidote/Opioid Antagonist] Uses: *Opi- oid addiction (diagnosis) & OD* Action: Competitive narcotic antagonist Dose: Adults. 0.4–2 mg IV, IM, or SQ q2–3 min; total dose 10 mg max Peds. 0.01–0.1 mg/kg/dose IV, IM, or SQ; repeat IV q3min × 3 doses PRN Caution: [B, ?] May precipitate acute withdrawal in addicts Disp: Inj 0.4, 1 mg/mL; neonatal inj 0.02 mg/mL SE: ↓ BP, tachycardia, irritability, GI upset, pulm edema Interactions: ↓ Effects OF opiates NIPE: If no response after 10 mg, suspect nonnarcotic cause Naltrexone (Depade, ReVia, Vivitrol) [Opioid Antagonist] WARNING: Can cause hepatic injury, contraindicated with active liver Dz Uses: *EtOH & narcotic addiction* Action: Antagonizes opioid receptors Dose: EtOH and narcotic addiction: 50 mg/d PO; do not give until opioid-free for 7–10 d; EtOH dependence: 380 mg IM q4wks (Vivitrol) Caution: [C, M] Contra: Acute hepatitis, liver failure, opioid use Disp: Tabs 50 mg; inj 380 mg (Vivitrol) SE: May cause hepatotox; insomnia, GI upset, joint pain, HA, fatigue Interactions: ↑ Lethargy & somnolence W/ thioridazine; ↓ effects OF opioids Labs: ↑ LFTs NIPE: Give IM in gluteal muscle & rotate Naphazoline (Albalon, AK-Con, Naphcon, others), Napha- zoline & Pheniramine Acetate (Naphcon A) [Ophthalmic Antihistamine] Uses: *Relieve ocular redness & itching caused by allergy* Action: Sympathomimetic (α-adrenergic vasoconstrictor) & antihistamine (pheniramine) Dose: 1–2 gtt up to qid, 3-d max Caution: [C, +] Contra: 202 Naproxen

NAG, in children, w/ contact lenses SE: CV stimulation, dizziness, local irritation Disp: Ophthalmic 0.012, 0.025, 0.1%/15 mL; naphazoline & pheniramine 0.025%/0.3% soln; Interactions: ↑ Risk of HTN crisis W/ MAOIs, TCAs Naproxen (Aleve [OTC], Naprosyn, Anaprox) [Analgesic, Anti-inflammatory, Antipyretic/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose: Adults & Peds >12 y. 200–500 mg bid–tid to 1500 mg/d max; ↓ in hepatic impair Caution: [B (D 3rd tri), +] Contra: NSAID or ASA triad sensitivity, peptic ulcer, post CABG for pain, 3rd tri PRG Disp: Tabs: 220, 250, 375, 500 mg; Delayed release: 375 mg, 500 mg; Controlled release: 375 mg, 550 mg; susp 125 mL/5 mL. SE: Dizziness, pruritus, GI upset, peptic ulcer, edema Interactions: ↑ Effects W/ aminoglycosides; ↑ effects OF anticoagulants, hypoglycemics, Li, MTX, thrombolytics; ↑ GI effects W/ ASA, corticosteroids, K supls, NSAIDs, EtOH; ↓ effects OF antihypertensives, diuretics Labs: ↑ BUN, Cr, LFTs, PT NIPE: Take W/ food to < GI upset Naratriptan (Amerge) [Migraine Suppressant/5-HT Ago- nist] Uses: *Acute migraine* Action: Serotonin 5-HT1 receptor antagonist Dose: 1–2.5 mg PO once; repeat PRN in 4 h; 5 mg/24 h max; ↓ in mild renal/hepatic insuff, take w/ fluids Caution: [C, M] Contra: Severe renal/hepatic impair, avoid w/ angina, ischemic heart Dz, uncontrolled HTN, cerebrovascular synds, & ergot use Disp: Tabs 1, 2.5 mg SE: Dizziness, sedation, GI upset, paresthesias, ECG changes, coronary vasospasm, arrhythmias Interactions: ↑ Effects W/ MAOIs, SSRIs; ↑ effects OF ergot drugs; ↓ effects W/ nicotine Natalizumab (Tysabri) [Immunomodulator/Monoclonal An- tibody] WARNING: Cases of progressive multifocal leukoencephalopathy (PML) reported Uses: *Relapsing MS to delay disability and ↓ recurrences*Ac- tion: Adhesion molecule inhibitor Dose: Adults. 300 mg IV q4wk; 2nd-line Tx only Contra: PML; immune compromise or w/ immunosuppressant Caution: [C,?/–] Baseline MRI to rule out PML Disp: Vial 300 mg SE: Infxn, immunosuppression; inf Rxn precluding subsequent use; HA, fatigue, arthralgia Interactions: ↑ Risk of Infxn W/ corticosteroids, immunosuppressants Labs: ↑ LFTs NIPE: Give slowly to ↓ Rxns; D/C immediately w/ signs of PML (weakness, paralysis, vision loss, impaired speech, cognitive ↓); eval at 3 and 6 mo, then q6mo there- after; limited distribution [TOUCH risk mgmt program (800) 456-2255] Nateglinide (Starlix) [Hypoglycemic/Amino Acid Deriva- tive] Uses: *Type 2 DM* Action: ↑ Pancreatic insulin release Dose: 120 mg ↓ PO tid 1–30 min ac; to 60 mg tid if near target HbA1c Caution: [C, –] w/ CYP2C9/3A4 metabolized drug (Table 11) Contra: DKA, type 1 DM Disp: Tabs 60, 120 mg SE: Hypoglycemia, URI Interactions: ↑ Effects of hypoglycemia W/ nonselective BBs, MAOIs, NSAIDs, salicylates, ↓ effects W/ corticosteroids, niacin, sympathomimetics, thiazide diuretics, thyroid meds Labs: ↓ Glucose NIPE: N Take med if meal skipped Neomycin, Colistin, & Hydrocortisone 203

Nedocromil (Tilade) [Anti-inflammatory/Respiratory Inhalant] Uses: *Mild–moderate asthma* Action: Anti-inflammatory agent Dose: Inhal: 2 inhal qid Caution: [B, ?/–] Contra: Component allergy Disp: Met-dose inhal 1.75 mg/spray SE: Chest pain, dizziness, dysphonia, rash, GI upset, Infxn NIPE: May take 2–4 wk for full therapeutic effect; not for acute asthma Nefazodone [Antidepressant/Serotonin Modulator] WARN- ING: Fatal hepatitis & liver failure possible, D/C if LFT >3× ULN, do not retreat; closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression* Action: ↓ Neuronal uptake of serotonin & norepinephrine Dose: Initial 100 mg PO bid; usual 300–600 mg/d in 2 ÷ doses Caution: [C, ?] Contra: w/ MAOIs, pimozide, carbamazepine, alprazolam; active liver Dz Disp: Tabs 50, 100, 150, 200, 250, 500 mg SE: Postural ↓ BP & allergic Rxns; HA, drowsiness, xerostomia, constipation, GI upset, liver failure Interactions: ↑ Risk of hypotension W/ antihypertensives, nitrates; ↑ effects OF alprazolam, CCB, digoxin, HMG-CoA reductase inhibitors, triazolam; ↑ risk of QT prolongation W/ astemizole, cisapride, pimozide; ↑ risk of serious and/or fatal Rxn W/ MAOIs; ↓ effects OF propranolol Labs: ↑ LFTs, cholesterol; ↓ Hct NIPE: Take w/o food; may take 2–4 wk for full therapeutic effects; monitor HR, BP Nelarabine (Arranon) [Antineoplastic/Antimetabolite] WARNING: Fatal neurotox possible Uses: *T-cell ALL or T-cell LBL unrespon- sive >2 other regimens* Action: Nucleoside analog Dose: Adults. 1500 mg/m2 IV over 2 h days 1, 3, 5 of 21-d cycle Peds. 650 mg/m2 IV over 1 h on days 1–5 of 21- d cycle Caution: [D,?/–] Disp: Vial 250 mg SE: Neuropathy, ataxia, Sz, coma, hematologic tox, GI upset, HA, blurred vision Labs: Monitor CBC NIPE: Prehy- dration, urinary alkalinization, allopurinol before dose Nelfinavir (Viracept) [Antiretroviral/Protease Inhibitor] Uses: *HIV Infxn* Action: Protease inhibitor causes immature, noninfectious virion production Dose: Adults. 750 mg PO tid or 1250 mg PO bid. Peds. 25–35 mg/kg PO tid; take w/ food Caution: [B, ?] Many drug interactions Contra: Phenylke- tonuria, triazolam/midazolam use or drug dependent on CYP3A4 (Table 11) Disp: Tabs 250, 625 mg; powder 50 mg/g; SE: Food ↑ absorption; interacts w/ St. John’s wort; dyslipidemia, lipodystrophy, D, rash Interactions: ↑ Effects W/ erythromycin, ketoconazole, indinavir, ritonavir; ↑ effects OF barbiturates, carbamazepine, cisapride, ergot alkaloids, erythromycin, lovastatin, midazolam, phenytoin, saquinavir, simvastatin, triazolam; ↓ effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John’s Wort; ↓ effects OF OCP Labs: ↑ LFTs NIPE: Take W/ food; use barrier contraception Neomycin, Bacitracin, & Polymyxin B (Neosporin Oint- ment) (See Bacitracin, Neomycin, & Polymyxin B Topical) Neomycin, Colistin, & Hydrocortisone (Cortisporin-TC Otic Drops); Neomycin, Colistin, Hydrocortisone, & Thonzonium (Cor- tisporin-TC Otic Susp) [Antibiotic/Aminoglycoside] Uses: *External 204 Neomycin & Dexamethasone otitis,* Infxns of mastoid/fenestration cavities Action: Antibiotic w/ anti-inflammatory Dose: Adults. 4–5 gtt in ear(s) tid–qid. Peds. 3–4 gtt in ear(s) tid–qid Con- tra: Component allergy; HSV, vaccinia, varicella Caution: [C, ?] Disp: Otic gtt & susp SE: Local irritation Neomycin & Dexamethasone (AK-Neo-Dex Ophthalmic, NeoDecadron Ophthalmic) [Antibiotic/Corticosteroid] Uses: *Steroid-responsive inflammatory conditions of the cornea, conjunctiva, lid, & anterior segment* Action: Antibiotic w/ anti-inflammatory corticosteroid Dose: 1–2 gtt in eye(s) q3–4h or thin coat tid–qid until response, then ↓ to daily Caution: [C, ?] Disp: Cream neomycin 0.5%/dexamethasone 0.1%; oint neomycin 0.35%/dexamethasone 0.05%; soln neomycin 0.35%/dexamethasone 0.1% SE: Local irritation NIPE: Use under ophthalmologist’s supervision Neomycin & Polymyxin B (Neosporin Cream) [OTC] [Antibi- otic] Uses: *Infxn in minor cuts, scrapes, & burns* Action: Bactericidal Dose: Apply bid–qid Caution: [C, ?] Contra: Component allergy Disp: Cream neomycin 3.5 mg/polymyxin B 10,000 units/g SE: Local irritation NIPE: Differ- ent from Neosporin oint Neomycin, Polymyxin B, & Dexamethasone (Maxitrol) [An- tibiotic/Corticosteroid] Uses: *Steroid-responsive ocular conditions w/ bacterial Infxn* Action: Antibiotic w/ anti-inflammatory corticosteroid Dose: 1–2 gtt in eye(s) q3–4h; apply oint in eye(s) tid–qid Contra: Component allergy; viral fungal, TB eye Dz Caution: [C, ?] Disp: Oint neomycin sulfate 3.5 mg/polymyxin B sulfate 10,000 units/dexamethasone 0.1%/g; susp identical/5 mL SE: Local irritation NIPE: Use under supervision of ophthalmologist Neomycin-Polymyxin Bladder Irrigant [Neosporin GU Irrig- ant] [Antibiotic] Uses: *Continuous irrigant prevent bacteriuria & gram(–) bacteremia associated w/ indwelling catheter* Action: Bactericidal; not for Serratia sp or streptococci Dose: 1 mL irrigant in 1 L of 0.9% NaCl; cont bladder irrigation w/ 1 L of soln/24 h Caution: [D] Contra: Component allergy Disp: Soln neomycin sulfate 40 mg & polymyxin B 200,000 units/mL; amp 1, 20 mL SE: Neomycin ototox or nephrotox (rare) NIPE: Potential for bacterial/fungal super Infxn; not for inj Neomycin, Polymyxin, & Hydrocortisone (Cortisporin Oph- thalmic & Otic) [Antibiotic/Anti-inflammatory] Uses: *Ocular & otic bacterial Infxns* Action: Antibiotic & anti-inflammatory Dose: Otic: 3–4 gtt in the ear(s) tid–qid. Ophth: Apply a thin layer to the eye(s) or 1 gtt daily–qid Caution: [C, ?] Disp: Otic susp; ophth soln; ophth oint SE: Local irritation Neomycin, Polymyxin B, & Prednisolone (Poly-Pred Oph- thalmic) [Antibiotic/Corticosteroid] Uses: *Steroid-responsive ocular conditions w/ bacterial Infxn* Action: Antibiotic & anti-inflammatory Dose: 1–2 gtt in eye(s) q4–6h; apply oint in eye(s) tid–qid Caution: [C, ?] Disp: Susp neomycin 0.35%/polymyxin B 10,000 units/prednisolone 0.5%/mL SE: Irritation NIPE: Use under supervision of ophthalmologist Nevirapine 205

Neomycin Sulfate (Neo-Fradin, generic) [Antibiotic] WARN- ING: Systemic absorption of oral route may cause neuro/oto/nephrotox may result; respiratory paralysis possible with any route of admin Uses: *Hepatic coma, bowel prep* Action: Aminoglycoside, poorly absorbed PO; ↓ GI bacterial flora Dose: Adults. 3–12 g/24 h PO in 3–4 ÷ doses. Peds. 50–100 mg/kg/24 h PO in 3–4 ÷ doses Caution: [C, ?/–] Renal failure, neuromuscular disorders, hearing impair Contra: Intestinal obst Disp: Tabs 500 mg; PO soln 125 mg/5 mL SE: Hear- ing loss w/ long-term use; rash, N/V NIPE: Do not use parenterally (↑ tox); part of the Condon bowel prep; also topical form Neomycin Sulfate, Topical (Myciguent [OTC]) [Antibiotic] Uses: *Prevent skin Infxn* Action: Topical aminoglycoside Dose: Apply to skin and rub in Caution: [C, ?/–] Contra: Component allergy Disp: Cream 0.5% SE: Itching, rash, redness Nepafenac (Nevanac) [Analgesic, Anti-inflammatory, An- tipyretic/NSAID] Uses: *Inflammation post-cataract surgery* Action: NSAID Dose: 1 gtt in eye(s) tid 1 d before, and continue 14 d after surgery Contra: NSAID/ASA sensitivity Caution: [C,?/–] May ↑ bleeding time, delay healing, cause keratitis Disp: Susp 3 mL SE: Capsular opacity, visual changes, foreign body sensation, inc. IOP Interactions: ↑ Effects OF oral anticoagulants NIPE: Prolonged use ↑ corneal risk; remove contact lenses during use; shake well before use, separate from other drops by >5 min Nesiritide (Natrecor) [Vasodilator/Human B-Type Natri- uretic Peptide] Uses: *Acutely decompensated CHF* Action: Human B- type natriuretic peptide Dose: 2 μg/kg IV bolus, then 0.01 μg/kg/min IV Caution: [C, ?/–] When vasodilators are not appropriate Contra: SBP <90, cardiogenic shock Disp: Vials 1.5 mg SE: ↓ BP, HA, GI upset, arrhythmias Interactions: ↑ Hypotension W/ ACEIs, nitrates Labs: ↑ Cr NIPE: Requires continuous BP monitoring; some studies indicate ↑ in mortality Nevirapine (Viramune) [Antiretroviral/NNRTI] WARNING: Reports of fatal hepatotox even after short-term use; severe life-threatening skin Rxns (Stevens–Johnson, tox epidermal necrolysis, & allergic Rxns); monitor closely during 1st 8 wk of Rx Uses: *HIV Infxn* Action: Nonnucleoside RT inhibitor Dose: Adults. Initial 200 mg/d PO × 14 d, then 200 mg bid. Peds. <8 y: 4 mg/kg/d × 14 d, then 7 mg/kg bid. > 8 y: 4 mg/kg/d × 14 d, then 4 mg/kg bid max 200 mg/dose for peds (w/o regard to food) Caution: [B, +/–] OCP Disp: Tabs 200 mg; susp 50 mg/5 mL SE: Life-threatening rash; HA, fever, D, neutropenia, hepatitis Interactions: ↑ Effects W/ clarithromycin, erythromycin; ↓ effects W/ rifabutin, rifampin, St. John’s wort; ↓ effects OF clarithromycin, indinavir, ketoconazole, methadone, OCPs, protease inhibitors, warfarin NIPE: Use barrier contraception; HIV resistance when given as monotherapy; always use in combo w/ atleast 1 additional antiretroviral agent; N women if CD4 >250 or men >400 unless benefit > risk of hepatotox 206 Niacin

Niacin (Niaspan, Slo-Niacin) [Antilipemic/Vitamin B Complex] Uses: *Adjunct in significant hyperlipidemia* Action: Nicotinic acid, vitamin B3; ↓ lipolysis; ↓ esterification of triglycerides; ↑ lipoprotein lipase Dose: 1–6 g ÷ doses PO tid; 9 g/d max (w/ food) Caution: [A (C if doses >RDA), +] Contra: Liver Dz, peptic ulcer, arterial hemorrhage Disp: SR caps 125, 250, 400, 500 mg; tabs 50, 100, 250, 500 mg; SR tabs 150, 250, 500, 750, 1000 mg; elixir 50 mg/5 mL SE: Upper body/facial flushing & warmth; GI upset, flatulence, exacerbate peptic ulcer; HA, paresthesias, liver damage, gout, or altered glucose control in DM Interactions: ↑ Effects OF antihypertensives, anticoagulants; ↓ effects OF hypoglycemics, probenecid, sulfinpyrazone Labs: ↑ LFTs, glucose, uric acid NIPE: EtOH & hot beverages ↑ flushing; flushing ↓ by taking ASA or NSAID 30–60 min prior to dose Nicardipine (Cardene) [Antianginal/Antihypertensive/CCB] Uses: *Chronic stable angina & HTN*; prophylaxis of migraine Action: CCB Dose: Adults. PO: 20–40 mg PO tid. SR: 30–60 mg PO bid. IV: 5 mg/h IV cont inf; ↑ by 2.5 mg/h q15min to max 15 mg/h. Peds. PO: 20–30 mg PO q8h. IV: 0.5–5 μg/kg/min; ↓ in renal/hepatic impair Caution: [C, ?/–] Heart block, CAD Contra: Cardiogenic shock Disp: Caps 20, 30 mg; SR caps 30, 45, 60 mg; inj 2.5 mg/mL SE: Flushing, tachycardia, ↓ BP, edema, HA Notes: PO-to-IV conversion: 20 mg tid = 0.5 mg/h, 30 mg tid = 1.2 mg/h, 40 mg tid = 2.2 mg/h Interactions: ↑ Effects W/ cimetidine, grapefruit juice; ↑ effects OF cyclosporine; ↑ hypotension W/ antihypertensives, fentanyl, nitrates, quinidine, EtOH; ↑ dysrhythmias W/ digoxin, disopyramide, phenytoin; ↓ effects W/ NSAIDs, rifampin; high-fat food Labs: ↑ LFTs NIPE: ↑ Risk of photosensitivity—use sunscreen; take w/ food (not high fat) Nicotine Gum (Nicorette, Others) [OTC] [Smoking Deterrent/ Cholinergic] Uses: *Aid to smoking cessation, relieve nicotine withdrawal* Action: Systemic delivery of nicotine Dose: Chew 9–12 pieces/d PRN; max 24 pieces/d Caution: [C, ?] Contra: Life-threatening arrhythmias, unstable angina Disp: 2 mg, 4 mg/piece; mint, orange, original flavors SE: Tachycardia, HA, GI upset, hiccups Interactions: ↑ Effects W/ cimetidine; ↑ effects OF catecholamines, cortisol; ↑ hemodynamic & A-V blocking effects OF adenosine; ↓ effects W/ coffee, cola NIPE: Chew 30 min for full dose of nicotine; ↓ absorption W/ coffee, soda, juices, wine w/in 15 min; must stop smoking & perform behavior modification for max effect Nicotine Nasal Spray (Nicotrol NS) [Smoking Deterrent/ Cholinergic] Uses: *Aid to smoking cessation, relieve nicotine withdrawal* Action: Systemic delivery of nicotine Dose: 0.5 mg/actuation; 1–2 sprays/h, 10 sprays/h max Caution: [D, M] Contra: Life-threatening arrhythmias, unstable angina Disp: Nasal inhaler 10 mg/mL SE: Local irritation, tachycardia, HA, taste perversion Interactions: ↑ Effects W/ cimetidine, blue cohash; ↑ effects OF catecholamines, cortisol; ↑ hemodynamic & A-V blocking effects OF adenosine NIPE: N in pts W/ chronic nasal disorders or severe reactive airway Dz; ↑ incidence of cough; must stop smoking & perform behavior modification for max effect Nimodipine 207

Nicotine Transdermal (Habitrol, Nicoderm CQ [OTC], Nicotrol [OTC], Others) [Smoking Deterrent/Cholinergic] Uses: *Aid to smoking cessation; relief of nicotine withdrawal* Action: Systemic delivery of nicotine Dose: Individualized; 1 patch (14–21 mg/d), & taper over 6 wk Caution: [D, M] Contra: Life-threatening arrhythmias, unstable angina Disp: Habitrol & Nicoderm CQ: 7, 14, 21 mg of nicotine/24 h; Nicotrol: 5, 10, 15 mg/24 h SE: In- somnia, pruritus, erythema, local site Rxn, tachycardia Interactions: ↑ Effects W/ cimetidine, blue cohash; ↑ effects OF catecholamines, cortisol; ↑ hemodynamic & A-V blocking effects OF adenosine; ↑ HTN W/ bupropion NIPE: Change application site daily; Nicotrol worn for 16 h to mimic smoking patterns; others worn for 24 h; must stop smoking & perform behavior modification for max effect Nifedipine (Procardia, Procardia XL, Adalat, Adalat CC) [Antihypertensive, Antianginal/CCB] Uses: *Vasospastic or chronic stable angina & HTN*; tocolytic Action: CCB Dose: Adults. SR tabs 30–90 mg/d. Tocolysis: 10–20 mg PO q4–6h. Peds. 0.6–0.9 mg/kg/24 h ÷ tid–qid Caution: [C, +] Heart block, aortic stenosis Contra: Immediate-release preparation for urgent or emergent HTN; acute MI Disp: Caps 10, 20 mg; SR tabs 30, 60, 90 mg SE: HA common on initial Rx; reflex tachycardia may occur w/ regular release dosage forms; peripheral edema, ↓ BP, flushing, dizziness Interactions: ↑ Effects W/ antihypertensives, azole antifungals, cimetidine, cisapride, CCBs, diltiazem, famotidine, nitrates, quinidine, ranitidine, EtOH, grapefruit juice; ↑ effects OF digitalis glycosides, phenytoin, vincristine; ↓ effects W/ barbiturates, nafcillin, NSAIDs, phenobarbital, rifampin, St. John’s wort, tobacco; ↓ effects OFof quinidine Labs: ↑ LFTs NIPE: Adalat CC & Procardia XR not interchangeable; SL administration not OK; take w/o regard to food; ↑ risk of photosensitivity—use sunscreen Nilutamide (Nilandron) [Antineoplastic/Antiandrogen] WARNING: Interstitial pneumonitis possible; most cases in 1st 3 mo; follow CXR before Rx Uses: *Combo w/ surgical castration for met CAP* Action: Nons- teroidal antiandrogen Dose: 300 mg/d PO in ÷ doses × 30 d, then 150 mg/d Cau- tion: Not used in females Contra: Severe hepatic impair, resp insuff Disp: Tabs 150 mg SE: Interstitial pneumonitis, hot flashes, ↓ libido, impotence, N/V/D, gynecomastia, hepatic dysfunction Interactions: ↑ Effects OF phenytoin, theophylline, warfarin Labs: ↑ LFTs (monitor) NIPE: Take w/o regard to food; visual adaptation may be delayed; may cause Rxn when taken w/ EtOH Nimodipine (Nimotop) [Cerebral Vasodilator/CCB] Uses: *Prevent vasospasm following subarachnoid hemorrhage* Action: CCB Dose: 60 mg PO q4h for 21 d; ↓ in hepatic failure Caution: [C, ?] Contra: Component allergy Disp: Caps 30 mg SE: ↓ BP, HA, constipation Interactions: ↑ Effects W/ other CCB; grapefruit juice, EtOH; ↓ effects W/ ephedra, St. John’s wort, any food Labs: ↑ LFTs NIPE: Give via NG tube if caps cannot be swallowed whole, PO administration only; ↑ risk of photosensitivity—use sunscreen 208 Nisoldipine

Nisoldipine (Sular) [Antihypertensive/CCB] Uses: *HTN*Ac- tion: CCB Dose: 10–60 mg/d PO; ↓ start doses w/ elderly or hepatic impair Cau- tion: [C, ?] Disp: ER tabs 10, 20, 30, 40 mg SE: Edema, HA, flushing Interactions: ↑ Effects W/ antihypertensives, cimetidine, nitrates, EtOH, high-fat foods; ↓ effects W/ phenytoin, St. John’s wort NIPE: Do not take w/ grapefruit juice or high-fat meal Nitazoxanide (Alinia) [Antiinfective/Antiprotozoal] Uses: *Cryptosporidium sp or Giardia sp-induced D in pts 1–11 y* Action: Antiproto- zoal interferes w/ pyruvate ferredoxin oxidoreductase Spectrum: Cryptosporidium sp, Giardia sp Dose: Peds. 12–47 mo: 5 mL (100 mg) PO q12h × 3 d. 4–11 y: 10 mL (200 mg) PO q12h × 3 d; = 12 y: 500 mg q12h for 3 d take w/ food Caution: [B, ?] Disp: 100 mg/5 mL PO susp, 500 tab SE: Abd pain Interactions: ↑ Effects W/ warfarin NIPE: Susp contains sucrose, interacts w/ highly protein-bound drugs Nitrofurantoin (Macrodantin, Furadantin, Macrobid) [Uri- nary Anti-infective] WARNING: Pulm Rxns possible Uses: *Preven- tion & Rx UTI* Action: Bacteriostatic; interferes w/ carbohydrate metabolism. Spectrum: Some gram(+) & (–) bacteria; Pseudomonas sp, Serratia sp, & most Pro- teus sp-resistant Dose: Adults. Suppression: 50–100 mg/d PO. Rx: 50–100 mg PO qid. Peds. Suppression: 1–2 mg/kg/d in 1–2 ÷ doses, max 100 mg/d. Rx: 5–7 mg/kg/24 h in 4 ÷ doses (w/ food/milk/antacid) Caution: [B, +] Avoid w/ CrCl <60 mL/min, PRG at term Contra: Renal failure, infants <1 mo Disp: Caps 25, 50, 100 mg; susp 25 mg/5 mL SE: GI effects, dyspnea, various acute/chronic pulm Rxns, peripheral neuropathy Interactions: ↑ Effects W/ probenecid, sulfinpyrazone; ↓ effects W/ antacids, quinolones Labs: ↑ Serum bilirubin, alk phos NIPE: Take W/ food; may discolor urine; Macrocrystals (Macrodantin) cause < N than other forms Nitroglycerin (Nitrostat, Nitrolingual, Nitro-Bid Ointment, Nitro-Bid IV, Nitrodisc, Transderm-Nitro, Others) [Antiangi- nal, Vasodilator/Nitrate] Uses: *Angina pectoris, acute & prophylactic therapy, CHF, BP control* Action: Relaxes vascular smooth muscle, dilates coronary arteries Dose: Adults. SL: 1 tab q5min SL PRN for 3 doses. Translingual: 1–2 met-doses sprayed onto PO mucosa q3–5min, max 3 doses. PO: 2.5–9 mg tid. IV: 5–20 μg/min, titrated to effect. Topical: Apply 1/2 in. of oint to chest wall tid, wipe off at night. TD: 0.2–0.4 mg/h/patch daily; IV bolus: 12.5–25 μg; inf at 10–20 μg/min. SL: 0.3–0.4 mg, repeat q5min. Aerosol spray: Spray 0.5–1.0 s at 5-min intervals (ECC 2005) Peds. 0.25–0.5 μg/kg/min IV, titrate. Caution: [B, ?] Restric- tive cardiomyopathy Contra: IV: Pericardial tamponade, constrictive pericarditis. PO: w/ sildenafil, tadalafil, vardenafil, head trauma, NAG Disp: SL tabs 0.3, 0.4, 0.6 mg; translingual spray 0.4 mg/dose; SR caps 2.5, 6.5, 9; SR tabs 2.6, 6.5, 9.0 mg; inj 0.1, 0.2, 0.4 mg/mL (premixed); 5 mg/mL injection soln; oint 2%; TD patches 0.1, 0.2, 0.4, 0.6 mg/h; buccal CR 2, 3 mg SE: HA, ↓ BP, lightheadedness, GI upset Interactions: ↑ Hypotensive effects W/ antihypertensives, phenothiazine, sildenafil, tadalafil, vardenafil, EtOH; ↓ effects W/ ergot alkaloids; ↓ effects OF Norfloxacin 209

SL tabs & spray W/ antihistamines, phenothiazine, TCAs Labs: False ↑ cholesterol, triglycerides NIPE: Replace SL tabs q6mo & keep in original container; nitrate tolerance w/ chronic use after 1–2 wk; minimize by providing nitrate-free period daily, using shorter-acting nitrates tid, & removing LA patches & oint before sleep to ↓ tolerance Nitroprusside (Nipride, Nitropress) [Antihypertensive/Va- sodilator] Uses: *Hypertensive crisis, CHF, controlled ↓ BP periop (↓ bleeding)*, aortic dissection, pulm edema Action: ↓ Systemic vascular resistance Dose: Adult & Peds. 0.5–10 μg/kg/min IV inf, titrate; usual dose 3 μg/kg/min Caution: [C, ?] ↓ Cerebral perfusion Contra: High output failure, compensatory HTN Disp: Inj 25 mg/mL SE: Excessive hypotensive effects, palpitations, HA Interactions: ↑ Effects W/ antihypertensives, anesthetics, sildenafil, tadalafil, vardenafil; ↑ risk of arrhythmias W/ TCA Labs: ↑ Cr NIPE: Discard colored soln other than light brown; thiocyanate (metabolite w/ renal excretion) w/ tox at 5–10 mg/dL, more likely if used for >2–3 d; w/ aortic dissection use w/ β-blocker Nizatidine (Axid, Axid AR [OTC]) [Gastric Antisecretory/H2 Receptor Antagonist] Uses: *Duodenal ulcers, GERD, heartburn*Ac- tion: H2-Receptor antagonist Dose: Adults. Active ulcer: 150 mg PO bid or 300 mg PO hs; maint 150 mg PO hs. GERD: 150 mg PO bid. Heartburn: 75 mg PO bid. Peds. GERD: 10 mg/kg PO bid in ÷ doses, 150 mg bid max; ↓ in renal impair Caution: [B, +] Contra: H2-Receptor antagonist sensitivity Disp: Caps 75 [OTC], 150, 300 mg; sol 15 mg/mL SE: Dizziness, HA, constipation, D Interactions: ↑ Effects OF salicylates, EtOH; ↓ effects W/ antacids, tomato/mixed veg juice Labs: ↑ LFTs, uric acid NIPE: Smoking ↑ gastric acid secretion Norepinephrine (Levophed) [Adrenergic Agonist/Vasopres- sor/Sympathomimetic] Uses: *Acute ↓ BP, cardiac arrest (adjunct)* Action: Peripheral vasoconstrictor of arterial/venous beds Dose: Adults. 8–30 μg/min IV, titrate. Peds. 0.05–0.1 μg/kg/min IV, titrate Caution: [C, ?] Contra: ↓ BP due to hypovolemia Disp: Inj 1 mg/mL SE: Bradycardia, arrhythmia Notes: Correct volume depletion as much as possible before vasopressors; interaction w/ TCAs leads to severe HTN; use large vein to avoid extrav; phentolamine 5–10 mg/10 mL NS injected locally for extrav Interactions: ↑ HTN W/ antihistamines, BBs, ergot alkaloids, guanethidine, MAOIs, methyldopa, oxytocic meds, TCAs; ↑ risk of arrhythmias W/ cyclopropane, halothane Labs: ↑ Glucose NIPE: Correct volume depletion as much as possible before vasopressors; use large vein to avoid extrav; phentolamine 5–10 mg/10 mL NS injected locally for extrav Norethindrone Acetate/Ethinyl Estradiol Tablets (Femhrt) (See Estradiol/ Norethindrone Acetate) [Progestin & Estrogen] Norfloxacin (Noroxin, Chibroxin Ophthal) [Antibiotic/Fluo- roquinolone] Uses: *Complicated & uncomplicated UTI due to gram(–) bacteria, prostatitis, gonorrhea*, infectious D, conjunctivitis Action: Quinolone, ↓ DNA gyrase, bactericidal Spectrum: Broad gram(+) & (–) E. faecalis, E. coli, 210 Norgestrel

K. pneumoniae, P. mirabilis, P. aeruginosa, S. epidermidis, S. saprophyticus Dose: 400 mg PO bid; Gonorrhea: 800 mg single dose; Prostatitis: 400 mg PO bid; Gas- troenteritis, travelers D: 400 mg PO × 3–5 d ↓ w/ renal impair Adults & Peds. >1 y: Ophthal: 1 gtt each eye qid for 7 d Caution: [C, –] Tendinitis/tendon rupture, quinolone sensitivity Contra: h/o allergy or tendonitis w/ fluoroquinolones Disp: Tabs 400 mg; ophth 3 mg/mL SE: Photosens, HA, GI; ocular burning w/ ophth In- teractions: ↑ Effects W/ probenecid; ↑ effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin; ↓ effects W/ antacids, ↓ ↑ didanosine, Fe salts, Mg, sucralfate, NaHCO3, Zn; effects W/ food Labs: LFTs, BUN, SCr NIPE: N Give to children <18 y except for opth sol; ↑ fluids to 2–3 L/d; may cause photosensitivity—use sunscreen; good conc in the kidney & urine, poor blood levels; not for urosepsis Norgestrel (Ovrette) [Progestin] Uses: *PO contraceptive* Action: Prevent follicular maturation & ovulation Dose: 1 tab/d; begin day 1 of menses Caution: [X, ?] Contra: Thromboembolic disorders, breast CA, PRG, severe hepatic Dz Disp: Tabs 0.075 mg SE: Edema, breakthrough bleeding, thromboembolism Interactions: ↓ Effects W/ barbiturates, carbamazepine, hydantoins, griseofulvin, penicillins, rifampin, tetracyclines, St. John’s wort NIPE: Photosensi- tivity—use sunscreen; D/C drug if suspect PRG—use barrier contraception until confirmed progestin-only products have ↑ risk of failure in prevention of PRG Nortriptyline (Aventyl, Pamelor) [Antidepressant/TCA] Uses: *Endogenous depression* Action: TCA; ↑ synaptic CNS levels of serotonin &/or norepinephrine Dose: Adults. 25 mg PO tid–qid; >150 mg/d not OK. Elderly. 10–25 mg hs. Peds. 6–7 y: 10 mg/d. 8–11 y: 10–20 mg/d. >11 y: 25–35 mg/d, ↓ w/ hepatic insuff Caution: [D, +/–] NAG, CV Dz Contra: TCA allergy, use w/ MAOI Disp: Caps 10, 25, 50, 75 mg; soln 10 mg/5 mL SE: Anticholinergic (blurred vision, retention, xerostomia) Interactions: ↑ Effects W/ antihistamines, CNS depressants, cimetidine, fluoxetine, OCP, phenothiazine, quinidine, EtOH; ↑ effects OF anticoagulants; ↑ risk of HTN W/ clonidine, levodopa, sympathomimetics; ↓ effects W/ barbiturates, carbamazepine, rifampin Labs: ↑ Serum bilirubin, alkaline phosphatase NIPE: Concurrent use W/ MAOIs have resulted in HTN, Szs, death; ↑ risk of photosensitivity—use sunscreen; max effect after 2 wk Nystatin (Mycostatin) [Anti-infective/Antifungal] Uses: *Mu- cocutaneous Candida Infxns (oral, skin, vag)* Action: Alters membrane permeability. Spectrum: Susceptible Candida sp Dose: Adults & children. PO: 400,000–600,000 units PO “swish & swallow” qid. Vag: 1 tab vag hs × 2 wk. Topi- cal: Apply bid–tid to area. Peds. Infants: 200,000 units PO q6h. Caution: [B (C PO), +] Disp: PO susp 100,000 units/mL; PO tabs 500,000 units; troches 200,000 units; vag tabs 100,000 units; topical cream/oint 100,000 units/g, powder 100,000 units/g SE: GI upset, Stevens–Johnson synd NIPE: Store susp up to 10 d in refrigerator; not absorbed PO; not for systemic Infxns Olopatadine 211

Octreotide (Sandostatin, Sandostatin LAR) [Antidiarrheal/ Hormone] Uses: *↓ Severe D associated w/ carcinoid & neuroendocrine GI tumors (eg, VIPoma, ZE synd)*; bleeding esophageal varices Action: LA peptide; mimics natural hormone somatostatin Dose: Adults. 100–600 μg/d SQ/IV in 2–4 ÷ doses; start 50 μg daily–bid. Sandostatin LAR (depot): 10–30 mg IM q4wk Peds. 1–10 μg/kg/24 h SQ in 2–4 ÷ doses. Caution: [B, +] Hepatic/renal impair Disp: Inj 0.05, 0.1, 0.2, 0.5, 1 mg/mL; 10, 20, 30 mg/5 mL LAR depot SE: N/V, abd discomfort, flushing, edema, fatigue, cholelithiasis, hyper/hypoglycemia, hepatitis ↓ ↑ ↓ Interactions: Effects OF cyclosporine, vitamin B12 Labs: Small LFTs, serum thyroxine, vitamin B12 NIPE: May alter effects of hypoglycemics Ofloxacin (Floxin, Ocuflox Ophthalmic) [Antibiotic/Fluoro- quinolone] Uses: *Lower resp tract, skin & skin structure, & UTI, prostatitis, uncomplicated gonorrhea, & Chlamydia Infxns; topical (bacterial conjunctivitis; otitis externa; if perforated ear drum >12 y)* Action: Bactericidal; ↓ DNA gyrase. Broad spectrum gram(+) & (–): S. pneumoniae, S. aureus, S. pyogenes, H. influenzae, P. mirabilis, N. gonorrhoeae, C. trachomatis, E. coli Dose: Adults. 200–400 mg PO bid or IV q12h. Adults & Peds >1 y. Ophth: 1–2 gtt in eye(s) q2–4h for 2 d, then qid × 5 more d. Adults & Peds >12 y. Otic: 10 gtt in ear(s) bid for 10 d. Peds 1–12 y. Otic: 5 gtt in ear(s) for 10 d. ↓ in renal impair, take on empty stomach Caution: [C, –] ↓ Absorption w/ antacids, sucralfate, Al-, Ca-, Mg-, Fe-, Zn-containing drugs Contra: Quinolone allergy Disp: Tabs 200, 300, 400 mg; inj 20, 40 mg/mL; ophth & otic 0.3% SE: N/V/D, photosens, insomnia, HA, local irritation Notes: Ophth form OK in ears Interactions: ↑ Effects W/ cimetidine, probenecid; ↑ effects OF procainamide, theophylline, warfarin; ↑ risk of tendon rupture W/ corticosteroids; ↓ effects W/ antacids, antineoplastics, Ca, didanosine, Fe, ↑ NaHCO3, sucralfate, Zn NIPE: Take w/o food; use sunscreen; fluids to 2–3 L/d Olanzapine (Zyprexa, Zyprexa, Zydis) [Antipsychotic/ Thienobenzodiazepine] WARNING: Mortality in elderly w/ dementia- related psychosis Uses: *Bipolar mania, schizophrenia*, psychotic disorders, acute agitation in schizophrenia Action: Dopamine & serotonin antagonist; Dose: Bipolar/schizophrenia: 5–10 mg/d, ↑ weekly PRN, 20 mg/d max; Agitation: 5–10 mg IM q2–4h PRN, 30 mg d/max Caution: [C, –] Disp: Tabs 2.5, 5, 7.5, 10, 15, 20 mg; PO disint tabs 5, 10, 15, 20 mg; Inj 10 mg SE: HA, somnolence, orthostatic ↓ BP, tachycardia, dystonia, xerostomia, constipation Interactions: ↑ Effects W/ fluvoxamine; ↑ sedation W/ CNS depressants, EtOH; ↑ Szs W/ anticholinergics, CNS depressants; ↑ hypotension W/ antihypertensives, diazepam; ↓ effects W/ activated charcoal, carbamazepine, omeprazole, rifampin, St. John’s wort, tobacco; ↓ effects OF dopamine agonists, levodopa Labs: ↑ LFTs NIPE: ↑ Risk OF tardive dyskinesia, photosensitivity—use sunscreen, body temp impairment; takes weeks to titrate dose; smoking ↓ levels; may be confused w/ Zyrtec Olopatadine (Patanol) [Ophthalmic Antihistamine] Uses: *Allergic conjunctivitis* Action: H1-receptor antagonist Dose: 1–2 gtt in eye(s) 212 Olsalazine bid –allow 6–8 h between doses Caution: [C, ?] Disp: Soln 0.1% 5 mL SE: Local irritation, HA, rhinitis NIPE: N In children <3 y; may reinsert contacts 10 min later if eye not red Olsalazine (Dipentum) [Anti-inflammatory/Aminosalicylic Acid Derivative] Uses: *Maint remission in UC* Action: Topical anti- inflammatory Dose: 500 mg PO bid (w/ food) Caution: [C, M] Salicylate sensitivity Disp: Caps 250 mg SE: D, HA, blood dyscrasias, hepatitis Interaction: ↑ Effects OF anticoagulants Labs: ↑ LFTs NIPE: Food < GI upset Omalizumab (Xolair) [Antiasthmatic/Monoclonal Antibody] WARNING: Reports of anaphylaxis 2–24 h after administration, even in previously treated patients Uses: *Moderate–severe asthma in >/=12 y w/ reactivity to an allergen & when Sxs inadequately controlled w/ inhaled steroids* Action: Anti- IgE Ab Dose: 150–375 mg SQ q2–4wk (dose/frequency based on serum IgE level & BW, see package insert) Caution: [B,?/–] Contra: Component allergy, acute bronchospasm Disp: 150 mg single-use 5-mL vial SE: Site Rxn, sinusitis, HA, anaphylaxis reported in 3 pts Interactions: No drug interaction studies done NIPE: N D/C abruptly; not for acute bronchospasm; admin w/in 8 h of reconstitution and store in refrigerator; continue other asthma medications as indicated Omega-3 fatty acid [fish oil] (Louaza) [Lipid Regulator/ Ethyl Ester] Uses: *Rx hypertriglyceridemia* Action: Omega-3-acid ethyl esters, ↓ thrombus inflammation & triglycerides Dose: Hypertriglyceridemia: 4 g/d divided in 1–2 doses Caution: PRG risk factor [C,-] w/ anticoagulant use, w/ bleed risk Contra: Hypersensitivity to components Disp: 1000-mg gelcap SE: Dyspepsia, N, GI pain, rash, flulike Sxs Interactions: ↑ Effects OF anticoagulants Labs: Monitor triglycerides, LDL, ALT NIPE: Only FDA approved fish oil supplement; not for exogenous hypertriglyceridemia (type 1 hyperchylomicronemia); many OTC products; D/C after 2 mo if TG levels do not ↓; previously called “Omacor” Omeprazole (Prilosec, Zegerid) [Anti-Ulcer Agent/Proton Pump Inhibitor] Uses: *Duodenal/gastric ulcers, ZE synd, GERD*, H. pylori Infxns Action: Proton-pump inhibitor Dose: 20–40 mg PO daily–bid; Zegerid powder/mix; in small cup w/ 2 Tbsp H2O (not food or other Liq) refill and drink Caution: [C, –] Disp: DR tabs 20 mg; DR caps 10, 20, 40 mg; Zegerid powder for oral susp: 20, 40 mg. Zegerid caps 20, 40 mg SE: HA, D Interactions: ↑ Effects OF clarithromycin,digoxin, phenytoin, warfarin; ↓ effects W/ sucralfate; ↓ effects OF ampicillin, cyanocobalamin, ketoconazole Labs: ↑ LFTs; NIPE: Combo (ie, antibiotic) Rx for H. pylori, take Zegerid 1 h before meals preferably in AM Ondansetron (Zofran, Zofran ODT) [Antiemetic/5-HT Antag- onist] Uses: *Prevent chemo-associated & postop N/V* Action: Serotonin receptor antagonist Dose: Chemo: Adults & Peds. 0.15 mg/kg/dose IV prior to chemo, then 4 & 8 h after 1st dose or 4–8 mg PO tid; 1st dose 30 min prior to chemo & give on a schedule, not PRN. Postop: Adults. 4 mg IV immed preanesthesia Oral Contraceptives, Biphasic, Monophasic, Triphasic, Progestin Only 213 or postop. Peds. <40 kg: 0.1 mg/kg. >40 kg: 4 mg IV; ↓ dose w/ hepatic impair Caution: [B, +/–] Disp: Tabs 4, 8, 24 mg, soln 4 mg/5 mL, inj 2 mg/mL, 32 mg/ 50 mL; Zofran ODT tab, 4, 8 mg SE: D, HA, constipation, dizziness Interactions: ↓ Effects W/ cimetidine, phenobarbital, rifampin Labs: ↑ LFTs NIPE: Food ↑ absorption Oprelvekin (Neumega) [Thrombopoietic Growth Factor] WARNING: Allergic Rxn w/ anaphylaxis reported; D/C w/ any allergic Rxn Uses: *Prevent ↓ plt w/ chemo* Action: ↑ Proliferation & maturation of megakaryocytes (interleukin-11) Dose: Adults. 50 μg/kg/d SQ for 10–21 d. Peds. >12 y: 75–100 μg/kg/d SQ for 10–21 d. <12 y: Use only in clinical trials. Caution: [C, ?/–] Disp: 5 mg powder for inj SE: Tachycardia, palpitations, arrhythmias, edema, HA, dizziness, insomnia, fatigue, fever, N, anemia, dyspnea, allergic Rxns including anaphylaxis Interactions: None noted Labs: ↓ HMG, albumin NIPE: Monitor for peripheral edema; use med w/in 3 h of reconstitution Oral Contraceptives, Biphasic, Monophasic, Triphasic, Progestin Only (Table 6) [Progestin/Hormone] WARNING: Cigarette smoking ↑ risk of serious CV side effects; ↑ risk w/ >15 cig/d, >35 y; strongly advise women on OCPs not to smoke Uses: *Birth control; regulation of anovulatory bleeding; dysmenorrhea; endometriosis; polycystic ovaries; acne* (Note: FDA approvals vary widely, see insert) Action: Birth control: Suppresses LH surge, prevents ovulation; progestins thicken cervical mucus; ↓ fallopian tubule cilia, ↓ endometrial thickness to ↓ chances of fertilization. Anovulatory bleeding: Cyclic hormones mimic body’s natural cycle & regulate endometrial lining, results in regular bleeding q28d; may ↓ uterine bleeding & dysmenorrhea Dose: Start day 1 menstrual cycle or 1st Sunday after onset of menses; 28-d cycle pills take daily; 21-d cycle pills take daily, no pills during last 7 d of cycle (during menses); some available as transdermal patch Caution: [X, +] Migraine, HTN, DM, sickle cell Dz, gallbladder Dz; monitor for breast Dz, K+ if taking drugs with ↑ K+ risk Contra: AUB, PRG, estrogen-dependent malignancy, ↑ hypercoagulation/liver Dz, hemiplegic migraine, smokers >35 y Disp: 28-d cycle pills (21 active pills + 7 placebo or Fe supplement); 21-d cycle pills (21 active pills) SE: Intramenstrual bleeding, oligomenorrhea, amenorrhea, ↑ appetite/wt gain, ↓ libido, fatigue, depression, mood swings, mastalgia, HA, melasma, ↑ vaginal discharge, acne/greasy skin, corneal edema, N NIPE: Taken correctly, 99.9% effective for contraception; no STDs prevention, use additional barrier contraceptive; long-term, can ↓ risk of ectopic PRG, benign breast Dz, ovarian & uterine CA. Rx for menstrual cycle control: Start w/monophasic × 3 mo before switching to another brand; w/ continued bleed, change to pill w/↑estrogen; Rx for birth control: Choose pill w/ lowest SE profile for particular pt; SEs numerous; due to estrogenic excess or progesterone deficiency; each pill’s SE profile can be unique (see insert); newer extended cycle combo have shorter/fewer hormone free intervals ? ↓ PRG risk; OCP troubleshooting SE w/ sug- gested OCP: 214 Orlistat

• Absent menstrual flow: ↑ Estrogen, ↓ progestin: Brevicon, Necon 1/35, Norinyl 1/35, Modicon, Necon 1/50, Norinyl 1/50, Ortho-Cyclen, Ortho-Novum 1/50, Ortho-Novum 1/35, Ovcon 35 • Acne: Use ↑ estrogen, ↓ androgenic: Brevicon, Cyclen, Demulen 1/50, Othro-Tri Cyclen, Mircette, Modicon, Necon, Ortho Evra, Yasmin • Break through bleed:↑ Estrogen, ↑ progestin, ↓ androgenic: Demulen 1/50, Des- ogen, Estrostep, Loestrin 1/20, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E • Breast tenderness or ↑ wt: ↓ Estrogen, ↓ progestin: use ↓ estrogen pill than current; Alesse, Levlite, Loestrin 1/20 Fe, Ortho Evra Yasmin • Depression: ↓ Progestin: Alesse, Brevicon, Levlite, Modicon, Necon, Ortho Evra, Ovcon 35, Othro-Cyclen, Ortho-TriCyclen Tri-Levlen, Triphasil, Trivora • Endometriosis: ↓ Estrogen, ↑ progestin: Demulen 1/35, Loestrin 1.5/30, Loestrin 1/20 Fe, LoOvral, Levlen, Levora, Nordette, Zovia 1/35; continuous w/0 placebo pills or w/ 4 d of placebo pills • HA: ↓ Estrogen, ↓ progestin: Alesse, Levlite, Ortho Evra • Moodiness or irritability: ↓ Progestin: Alesse, Brevicon, Levlite, Modicon, Necon 1/35, Ortho Evra, Ortho-Cyclen, Ortho Tri-Cyclen, Ovcon 35, Tri-Levlen, Triphasil, Trivora • Severe menstrual cramping: ↑ Progestin: Demulen 1/50, Desogen, Loestrin 1.5/30, Mircette, Ortho-Cept ,Yasmin, Zovia 1/50E, Zovia 1/35E Orlistat (Xenical, Alli [OTC]). [Obesity Management/GI Li- pase Inhibitor] Uses: *Manage obesity w/ BMI ≥30 kg/m2 or ≥27 kg/m2 w/ other risk factors; type 2 DM, dyslipidemia* Action: Reversible inhibitor of gastric & pancreatic lipases. Dose: 120 mg PO tid w/ a fat-containing meal; Alli (OTC) 60 mg po tid w/ fat-containing meals Caution: [B, ?] May ↓ cyclosporine & warfarin dose requirements Contra: Cholestasis, malabsorption Disp: Capsules 120 mg SE: Abd pain/discomfort, fatty stools, fecal urgency Interactions: ↑ Ef- fects OF pravastatin; ↓ effects OF cyclosporine, fat-soluble vitamins Labs: Moni- tor INR if taking warfarin, ↓ serum glucose, total cholesterol, LDL NIPE: Do not use if meal contains no fat; GI effects ↑ w/ higher-fat meals; supplement w/ fat-soluble vitamins Orphenadrine (Norflex) [Skeletal Muscle Relaxant] Uses: *Muscle spasms* Action: Central atropine-like effects cause indirect skeletal muscle relaxation, euphoria, analgesia Dose: 100 mg PO bid, 60 mg IM/IV q12h Cau- tion: [C, +] Contra: NAG, GI obst, cardiospasm, MyG Disp: Tabs 100 mg; SR tabs 100 mg; inj 30 mg/mL SE: Drowsiness, dizziness, blurred vision, flushing, tachycardia, constipation Interactions: ↑ CNS depression W/ anxiolytics, butorphanol, hypnotics, MAOIs, nalbuphine, opioids, pentazocine, phenothiazine, tramadol, TCAs, kava kava, valerian, EtOH; ↑ effects W/ anticholinergics NIPE: Impaired body temp regulation Oseltamivir (Tamiflu) [Antiviral/Neuraminidase Inhibitor] Uses: *Prevention & Rx influenza A & B* Action: ↓ Viral neuraminidase Dose: Oxazepam 215

Adults. Treatment 75 mg PO bid × 5 d Prophylaxis: 75 mg PO daily × 10 d Peds. PO bid dosing: <15 kg: 30 mg. 15–23 kg: 45 mg. 24–40 kg: 60 mg. >40 kg adult dose. ↓ w/ renal impair Caution: [C, ?/–] Contra: Component allergy Disp: Caps 75 mg, powder 12 mg/mL SE: N/V, insomnia, reports of neuropsychiatric events in children (self-injury, confusion, delirium) Interaction: ↑ Effects W/ probenecid NIPE: Take w/o regard to food; initiate w/in 48 h of Sx onset or exposure Oxacillin (Prostaphlin) [Antibiotic/Penicillin] Uses: *Infxns due to susceptible S. aureus & Streptococcus sp* Action: Bactericidal; ↓ Cell wall synth. Spectrum: Excellent gram(+), poor gram(–) Dose: Adults. 250–500 mg (2g severe) IM/IV q4–6h. Peds. 150–200 mg/kg/d IV ÷ q4–6h; ↓ w/ sig renal Dz Caution: [B, M] Contra: PCN sensitivity Disp: Powder for inj 500 mg, 1, 2, 10 g, soln 250 mg/5 mL SE: GI upset, interstitial nephritis, blood dyscrasias Interac- tions: ↑ Effects W/ disulfiram, probenecid; ↑ effects OF anticoagulants, MTX; ↓ effects W/ chloramphenicol, tetracyclines, carbonated drinks, fruit juice, food; ↓ effects OF OCPs NIPE: Take w/o food Oxaliplatin (Eloxatin) [Antineoplastic/Alkylating Agent] WARNING: Administer w/ supervision of health care provider experienced in chemo. Appropriate management is possible only w/ adequate diagnostic & Rx fa- cilities. Anaphylactic-like Rxns reported Uses: *Adjuvant Rx stage-III colon CA (primary resected) & met colon CA w/ 5-FU* Action: Metabolized to platinum derivatives, crosslink DNA Dose: Per protocol; see insert. Premedicate: Antiemetic w/ or w/o d examethasone Caution: [D, –] see Warning Contra: Allergy to components or platinum Disp: Inj 50, 100 mg SE: Anaphylaxis, granulocytopenia, paresthesia, N/V/D, stomatitis, fatigue, neuropathy, hepatotox Interactions: ↑ Effects OF nephrotoxic drugs Labs: ↑ Bilirubin, Cr, LFTs; ↓ HMG, K+, neutrophils, plts, WBC NIPE: Monitor CBC, plts, LFTs, BUN & Cr before each chemotherapy cycle; ↑ acute neurologic symptoms W/ cold exposure / cold Liq 5-FU & Leucov- orin are given in combo; epi, corticosteroids, & antihistamines alleviate severe Rxns Oxaprozin (Daypro, Daypro ALTA) [Analgesic, Anti-inflammatory, Antipyretic/NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins synth Dose: 600–1200 mg/d (÷ dose may help GI tolerance); ↓ in renal/hepatic impair Caution: [C (D in 3rd tri or near term), ?], peptic ulcer, bleeding disorders Contra: ASA/NSAID sensitivity perioperative pain w/ CABG Disp: Daypro ALTA tab 600 mg; caplets 600 mg SE: CNS inhibition, sleep disturbance, rash, GI upset, peptic ulcer, edema, renal failure, anaphylactoid Rxn with ASA triad (asthmatic w/ rhinitis, nasal polyps and bronchospasm w/ NSAID use) Inter- actions: ↑ Effects OF aminoglycosides, anticoagulants, ASA, Li, MTX, ↓ effects OF antihypertensives, diuretics NIPE: ↑ Risk of photosensitivity—use sunscreen; take w/ food Oxazepam [C-IV] [Anxiolytic/Benzodiazepines] Uses: *Anxi- ety, acute EtOH withdrawal*, anxiety w/ depressive Sxs Action: Benzodiazepine; 216 Oxcarbazepine metabolite of diazepam Dose: Adults. 10–15 mg PO tid–qid; severe anxiety & EtOH withdrawal may require up to 30 mg qid. Peds. 1 mg/kg/d ÷ doses Caution: [D, ?] Contra: Component allergy, NAG Disp: Caps 10, 15, 30 mg; tabs 15 mg SE: Sedation, ataxia, dizziness, rash, blood dyscrasias, dependence Interactions: ↑ CNS effects W/ anticonvulsants, antidepressants, antihistamines, barbiturates, MAOIs, opioids, phenothiazine, kava kava, lemon balm, sassafras, valerian, EtOH; ↑ effects W/ cimetidine; ↓ effects W/ OCPs, phenytoin, theophylline, tobacco; ↓ effects OF levodopa Labs: False ↑ serum glucose NIPE: N D/C abruptly Oxcarbazepine (Trileptal) [Anticonvulsant/Carbamazepine] Uses: *Partial Szs*, bipolar disorders Action: Blocks voltage-sensitive Na+ chan- nels, stabilization of hyperexcited neural membranes Dose: Adults. 300 mg PO bid, ↑ weekly to target maint 1200–2400 mg/d. Peds. 8–10 mg/kg bid, 600 mg/d max, ↑ weekly to target maint dose; ↓ w/ renal insuff Caution: [C, –] Carba- mazepine sensitivity; Contra: Components sensitivity Disp: Tabs 150, 300, 600 mg; Susp 300 mg/5 mL SE: ↓ Na+, HA, dizziness, fatigue, somnolence, GI upset, diplopia, concentration difficulties, fatal skin/multiorgan hypersensitivity Rxns In- teractions: ↑ Effects W/ benzodiazepines, EtOH; ↑ effects OF phenobarbital, phenytoin; ↓ effects W/ barbiturates, carbamazepine, phenobarbital, valproic acid, verapamil; ↓ effects OF CCBs, OCPs Labs: ↓ Thyroid levels, serum Na; Na+ if fatigued NIPE: Take w/o regard to food; use barrier contraception; do not abruptly D/C,; advise about Stevens–Johnson synd and topic epidermal necrolysis Oxiconazole (Oxistat) [Antifungal] Uses: *Tinea cruris, corporis, pedis, versicolor * Action: ? ↓ Ergosterols in fungal cell membrane Spectrum: Most E.floccosum, T. mentagrophytes, T. rubrum, M. furfur Dose: Apply thin layer daily–bid Caution: [B, M] Contra: Component allergy Disp: Cream, lotion 1% SE: Local irritation Oxybutynin (Ditropan, Ditropan XL) [GU Antispasmodic/ Anticholinergic] Uses: *Symptomatic relief of urgency, nocturia, incontinence w/ neurogenic or reflex neurogenic bladder* Action: Anicholinergic, relaxes bladder smooth muscle, ↑ bladder capacity Dose: Adults & Peds. >5 y: 5 mg PO tid–qid; XR 5 mg PO daily; ↑ to 30 mg/d PO (5 & 10 mg/tab). Peds. 1–5 y: 0.2 mg/kg/dose bid–qid (syrup 5 mg/5 mL); ↓ in elderly; periodic drug holidays OK Caution: [B, ?] Contra: NAG, MyG, GI/GU obst, ulcerative colitis, megacolon Disp: Tabs 5 mg; XR tabs 5, 10, 15 mg; syrup 5 mg/5 mL SE: Anticholinergic (drowsiness, xerostomia, constipation, tachycardia) Interactions: ↑ Effects W/ CNS depressants, EtOH; ↑ effects OF atenolol, digoxin, nitrofurantoin; ↑ anticholinergic effects W/ antihistamines, anticholinergics; ↓ effects OF haloperidol, levodopa NIPE: ↓ Temp regulation; ↑ photosensitivity—use sunscreen; ER form shell expelled in stool Oxybutynin Transdermal System (Oxytrol) [GU Antispas- modic/Anticholinergic] Uses: *Rx OAB* Action: Anicholinergic, relaxes bladder smooth muscle, ↑ bladder capacity ↑ Dose: One 3.9 mg/d system Oxycodone & Aspirin 217 apply 2×/wk (every 3–4 d) to abdomen, hip, or buttock Caution: [B, ?/–] Contra: GI/GU obst, NAG Disp: 3.9 mg/d transdermal patch SE: Anticholinergic, itching/redness at site Interactions: ↑ Effects W/ anticholinergics NIPE: Metabo- lized by the cytochrome P450 CYP3A4 enzyme system; do not apply to same site w/in 7 d Oxycodone [Dihydrohydroxycodeinone] (OxyContin, OxyIR, Roxicodone) [C-II] [Opioid Analgesic] WARNING: High abuse potential; CR only for extended chronic pain, not for PRN use; 80 mg ER tabs only for opioid tolerant patients Uses: *Moderate/severe pain, usually in combo w/ nonnarcotic analgesics* Action: Narcotic analgesic Dose: Adults. 5 mg PO q6h PRN (immed release); Mod-severe chronic pain 10–160 mg PO q12h (XR) Peds. 6–12 y: 1.25 mg PO q6h PRN. >12 y: 2.5 mg q6h PRN; ↓ w/ severe liver/renal Dz, elderly; w/ food Caution: [B (D if prolonged use/near term), M] Contra: Allergy, resp depression, acute asthma, ileus w/ microsomal morphine Disp: Immed-release caps (OxyIR) 5 mg; tabs (Percolone) 5 mg; CR Roxicodone tabs 5, 15, 30 mg; XR (OxyContin) 10, 20, 40, 80 mg; Liq 5 mg/5 mL; soln conc 20 mg/mL SE: ↓ BP, sedation, dizziness, GI upset, constipation, risk of abuse Interactions: ↑ CNS & resp. depression W/ amitriptylline, barbiturates, cimetidine, clomipramine, MAOIs, nortriptyline, protease inhibitors, TCAs Labs: ↑ Serum amylase, lipase NIPE: Take w/ food; OxyContin for chronic CA pain; do not crush/chew/cut ER prod; sought after as drug of abuse Oxycodone & Acetaminophen (Percocet, Tylox) [C-II] [Nar- cotic Analgesic Uses: *Moderate–severe pain* Action: Narcotic analgesic Dose: Adults. 1–2 tabs/caps PO q4–6h PRN (acetaminophen max dose 4 g/d). Peds. Oxycodone 0.05–0.15 mg/kg/dose q4–6h PRN, 5 mg/dose max Caution: [C (D prolonged use or near term), M] Contra: Allergy, resp depression Disp: Per- cocet tabs, mg oxycodone/mg APAP: 2.5/325, 5/325, 7.5/325, 10/325, 7.5/500, 10/650; Tylox caps 5 mg oxycodone, 500 mg APAP; soln 5 mg oxycodone & 325 mg APAP/5 mL SE: ↓ BP, sedation, dizziness, GI upset, constipation Interactions: ↑ CNS & resp depression W/ amitriptylline, barbiturates, cimetidine, clomipramine, MAOIs, nortriptylline, protease inhibitors, TCAs Labs: False ↑ serum amylase, lipase NIPE: Take w/ food Oxycodone & Aspirin (Percodan, Percodan-Demi) [C-II] [Nar- cotic Analgesic/Nonsteroidal Analgesic] Uses: *Moderate– moderately severe pain* Action: Narcotic analgesic w/ NSAID Dose: Adults. 1–2 tabs/ caps PO q4–6h PRN. Peds. Oxycodone 0.05–0.15 mg/kg/dose q4–6h PRN, up to 5 mg/dose; ↓ in severe hepatic failure Caution: [D (prolonged use or near term), M] Peptic ulcer Contra: Component allergy, children (<16 y) with viral Infxn, resp depression, ileus Disp: Percodan 4.5 mg oxycodone hydrochloride, 0.38 mg oxycodone terephthalate, 325 mg ASA; Percodan-Demi 2.25 mg oxycodone hydrochloride, 0.19 mg oxycodone terephthalate, 325 mg ASA SE: Seda- tion, dizziness, GI upset, constipation Interactions: ↑ CNS & resp depression W/ 218 Oxycodone/Ibuprofen amitriptyline, barbiturates, cimetidine, clomipramine, MAOIs, nortriptylline, protease inhibitors, TCAs; ↑ effects OF anticoagulants Labs: ↑ Serum amylase, lipase NIPE: Take w/ food Oxycodone/Ibuprofen (Combunox) [C-II] [Narcotic Anal- gesic/NSAID] WARNING: May ↑ risk of serious CV events; contra in periop CABG pain; ↑ risk of GI events such as bleeding Uses: *Short-term (not >7 d) management of acute moderate–severe pain* Action: Narcotic w/ NSAID Dose: 1 tab q6h PRN 4 tab max/24 h; 7 d max. Caution: [C, –] w/ impaired renal/hepatic Fxn; COPD, CNS depression Contra: Paralytic ileus, 3rd tri PRG, allergy to ASA or NSAIDs, where opioids are contraindicated Disp: Tabs 5 mg oxycodone/400 mg ibuprofen SE: N/V, somnolence, dizziness, sweating, flatulence Interactions: ↑ CNS & resp. depression W/ amitriptyline, barbiturates, cimetidine, clomipramine, MAOIs, nortriptyline , protease inhibitors, TCAs; ↑ effects W/ ASA, corticosteroids, probenecid, EtOH; ↑ effects OF aminoglycosides, anticoagulants, digoxin, hypoglycemics, Li, MTX; ↑ risks of bleeding W/ abciximab, cefotetan, valproic acid, thrombolytic drugs, warfarin, ticlopidine, garlic, ginger, ginkgo biloba; ↓ effects W/ feverfew; ↑ effects OF antihypertensives Labs: ↑ Serum amylase, lipase, LFTs, BUN, Cr NIPE: Take w/ food; monitor renal Fxn; abuse potential w/ oxycodone Oxymorphone (Opana,Opana ER) [C-II] [Opioid Analgesic] WARNING: (Opana ER) Abuse potential, CR only for chronic pain; do not consume EtOH-containing beverages, may cause fatal OD Uses: *Moderate/severe pain, sedative* Action: Narcotic analgesic Dose: 10–20 mg PO q4–6h PRN if opioid-naïve or 1–1.5 mg SC/IM q4–6h PRN or 0.5 mg IV q4–6h PRN; start 20 mg/dose max PO; Chronic pain: XR 5 mg PO q12h; if opioid-naïve ↑ PRN 5–10 mg PO q12h q3–7d; take 1h pc or 2h ac; ↓ dose w/ elderly, renal/hepatic impair Caution: [B, ?] Contra: ↑ ICP, severe resp depression, w/ EtOH or liposomal morphine, severe hepatic impair Disp: Tab 5, 10 mg; ER 5, 10, 20, 40 SE: ↓ BP, sedation, GI upset, constipation, histamine release Interactions: ↑ Effects W/ CNS depressants, cimetidine, neuroleptics, EtOH; ↓ effects W/ phenothiazines Labs: ↑ Amylase, lipase NIPE: Related to hydromorphone Oxytocin (Pitocin) [Oxytocic/Hormone] Uses: *Induce labor, control postpartum hemorrhage*; promote milk letdown in lactating women Action: Stimulate muscular contractions of the uterus & milk flow during nursing Dose: 0.0005–0.001 units/min IV inf; titrate 0.001–0.002 units/min q30–60min. Breast- feeding: 1 spray in both nostrils 2–3 min before feeding Caution: [Uncategorized, no anomalies expected, +/–] Contra: Where vaginal delivery not favorable, fetal distress Disp: Inj 10 units/mL; nasal soln 40 units/mL SE: Uterine rupture, fetal ↑ death; arrhythmias, anaphylaxis, H2O intox Interactions: Pressor effects W/ sympathomimetics NIPE: Monitor vital signs; nasal form for breast-feeding only Paclitaxel (Taxol, Abraxane) [Antineoplastic/Antimitotic] WARNING: Administration only by health care provider experienced in chemotherapy; fatal anaphylaxis and hypersensitivity possible; severe myelosuppression Paliperidone 219 possible Uses: *Ovarian & breast CA, PCa*, Kaposi sarcoma, NSCLC Action: Mitotic spindle poison; promotes microtubule assembly & stabilization against de- polymerization Dose: Per protocols; use glass or polyolefin containers (eg, nitroglycerin tubing set); PVC sets leach plasticizer; ↓in hepatic failure Caution: [D, –] Contra: Neutropenia <1500 WBC/mm3; solidtumors, component allergy Disp: Inj 6 mg/mL, 5 mg/mL albumin bound (Abraxane) SE: ↓ BM, peripheral neuropathy, transient ileus, myalgia, bradycardia, ↓ BP, mucositis, N/V/D, fever, rash, HA, phlebitis; hematologic tox schedule-dependent; leukopenia dose-limiting by 24-h inf; neurotox limited w/ short (1–3 h) inf; allergic Rxns (dyspnea, ↓ BP, urticaria, rash) Interactions: ↑ Effects W/ cyclosporine, dexamethasone, diazepam,ketoconazole, midazolam, quinidine, teniposide, verapamil, vincristine; ↑ risk of bleeding W/ anticoagulants, plt inhibitors, thrombolytics; ↑ myelosuppression when cisplatin is admin before paclitaxel; ↓ effects W/ carbamazepine, phenobarbital; ↓ effects of live-virus vaccines Labs: ↑ AST, alkaline phosphatase, triglycerides NIPE: N PRG, breast-feeding, live-virus vaccines; use barrier contraception; maintain hydration; allergic Rxn usually w/in 10 min of inf; minimize w/ corticosteroid, antihistamine pretreatment Palivizumab (Synagis) [Antiviral/Monoclonal Antibody] Uses: *Prevent RSV Infxn* Action: MoAb Dose: Peds. 15 mg/kg IM monthly, typically Nov–Apr Caution: [C, ?] Renal/hepatic dysfunction Contra: Compo- nent allergy Disp: Vials 50, 100 mg SE: URI, rhinitis, cough, local irritation Labs:?↑ LFT NIPE: Use drug w/in 6 h after reconstitution; N inj in gluteal site; for prophylaxis Palifermin (Kepivance) [Growth Factor/Keratinocyte Growth Factor] Uses: *Oral mucositis w/ BMT * Action: Synthetic keratinocyte GF Dose: Phase 1: 60 μg/kg IV daily × 3, 3rd dose 24–48 h before chemo Phase 2: 60 μg/kg IV daily × 3, immediately after stem cell inf Caution: [C, ?/–] Contra: N/A Disp: Inj 6.25 mg SE: Unusual mouth sensations, tongue thickening, rash LABS: ↑ Amylase, lipase NIPE: Eval for rash & taste alterations; E coli- derived; separate phases by 4 d; safety unknown w/ nonhematologic malignancies Palonosetron (Aloxi) [Antiemetic/5-HT3 Antagonist] WARNING: May ↑ QTc interval Uses: *Prevention acute & delayed N/V w/ emetogenic chemo* Action: 5-HT3 receptor antagonist Dose: 0.25 mg IV 30 min prior to chemo; do not repeat w/in 7 d Caution: [B, ?] Contra: Component allergy Disp: 0.25 mg/5 mL vial SE: HA, constipation, dizziness, abd pain, anxiety Inter- actions: Potential for drug interactions low Paliperidone (Invega) [Benzisoxazole] WARNING: Not for dementia-related psychosis Uses: *Schizophrenia* Action: Risperidone metabolite, antagonizes dopamine receptors Dose: 6 mg PO qAM, 12 mg/d max; CrCl 50–79; 6 mg/d max; CrCl 10–49 3 mg/d max Caution: [C; ?/–] w/ bradycardia, ↓ K+/Mg2+, renal/hepatic impair Contra: Risperidone hypersensitivity, w/ phenothiazine, ranolazine, ziprasidone, prolonged QT, h/o arrhythmia Disp: ER Tabs 3, 6, 9 mg 220 Pamidronate

SE: Impaired temp regulation, ↑ QT and HR, HA, anxiety, dizziness, N, dry mouth, fatigue, EPS Interactions: ↑ Risk of prolongation of QT W/ Class 1A & III antiarrhythmics, chlorpromazine, chlorpromazine, thioridazine, gatifloxacin, moxifloxacin, EtOH Labs: Monitor LFTs NIPE: Do not chew/cut/crush pill; monitor for orthostatic effects Pamidronate (Aredia) [Antihypercalcemic/Bisphosphonate] Uses: *↑ Ca2+ of malignancy, Paget Dz, palliate symptomatic bone metastases* Action: ↓ Nl & abnormal bone resorption Dose: ↑ Ca2+: 60 mg IV over 4 h or 90 mg IV over 24 h. Paget Dz: 30 mg/d IV slow inf for 3 d Caution: [D, ?/–] Avoid invasive dental procedures w/ use Contra: PRG Disp: Inj 30, 60, 90 mg SE: Fever, inj site Rxn, uveitis, fluid overload, HTN, abd pain, N/V, constipation, UTI, bone pain, hypophosphatemia; jaw osteonecrosis, perform dental exam pretherapy In- teractions: ↓ Serum Ca levels W/ foscarnet; ↓ effects W/ Ca, vitamin D Labs: ↓ K+, Ca2+, Mg2+ NIPE: N Ingest food W/ Ca or vitamins W/ minerals before or 2–3 h after admin of drug Pancrelipase (Pancrease, Cotazym, Creon, Ultrase) [Pan- creatic Enzyme] Uses: *Exocrine pancreatic secretion deficiency (eg, CF, chronic pancreatitis, pancreatic insuff), steatorrhea of malabsorption* Action: Pan- creatic enzyme supl Dose: 1–3 caps (tabs) w/ meals & snacks; ↑ to 8 caps (tabs); do not crush or chew EC products; dose-dependent on digestive requirements of pt; avoid antacids Caution: [C, ?/–] Contra: Pork product allergy, acute pancreatitis Disp: Caps, tabs SE: N/V, abd cramps Notes: Individualize therapy Interactions: ↓ Effects W/ antacids w/ Ca or Mg; ↓ effects OF Fe Labs: ↑ Serum and urine uric acid NIPE: Take w/ food; stress adherence to diet (usually low-fat, high-protein, high-calorie) Pancuronium (Pavulon) [Skeletal Muscle Relaxant/Nonde- polarizing Neuromuscular Blocking Agent] Uses: *Paralysis w/ mechanical ventilation* Action: Nondepolarizing neuromuscular blocker Dose: Adults. 2–4 mg IV q2–4h PRN. Peds. 0.02–0.1 mg/kg/dose q2–4h PRN; ↓ in renal/hepatic impair; intubate pt & keep on controlled ventilation; use adequate sedation or analgesia Caution: [C, ?/–] Contra: Component or bromide sensitivity Disp: Inj 1, 2 mg/mL SE: Tachycardia, HTN, pruritus, other histamine Rxns Interactions: ↑ Effects W/ amikacin, clindamycin, Li, quinidine, succinylcholine, gentamicin, streptomycin, verapamil; ↓ effects W/ carbamazepine, phenytoin, theophylline NIPE: Neuromuscular blocker does not alter pain, use analgesics for pain Panitumumab (Vectibix) [Human Epidermal Growth Factor Receptor (EGFR) Inhibitor] WARNING: Derm tox common (89%) and severe in 12%; can be associated w/ Infxn (sepsis, abscesses requiring I&D); w/ severe derm tox, hold or D/C and monitor for Infxns; severe inf Rxns (anaphylactic Rxn, bronchospasm, fever, chills, hypotension) in 1%; w/ severe Rxns, immediately D/C inf & possibly permanent discontinuation Uses:* Rx EGFR-expressing Pegfilgrastim 221 metastatic colon CA* Action: Anti-EGFR MoAB Dose: 6 mg/kg IV inf over 60 min q14d; doses >1000 mg over 90 min. ↓ inf rate by 50% w/ grade 1–2 inf Rxn, D/C permanently w/ grade 3–4 Rxn. For derm tox, hold until 1 mo permanently D/C. If ↓ dose tolerated, ↑ dose by 25% Caution: [C; -] D/C nursing during, 2 mo after Disp: Vial 20 mg/mL SE: Rash, acneiform dermatitis, pruritus, paronychia, ↓ Mg2+, abd pain, N/V/D, constipation, fatigue, dehydration, photosens, conjunctivitis, ocular hyperemia, ↑ lacrimation, stomatitis, mucositis, pulm fibrosis, severe derm tox, inf Rxns Labs: Lytes; NIPE: May impair female fertility; wear sunscreen/hats, limit sun exposure Pantoprazole (Protonix) [Gastric Acid Suppressant/Proton Pump Inhibitor] Uses: *GERD, erosive gastritis*, ZE synd, PUD Action: Proton-pump inhibitor Dose: 40 mg/d PO; do not crush/chew tabs; 40 mg IV/d (not >3 mg/min, use Protonix filter) Caution: [B, ?/–] Disp: Tabs, delayed release 20, 40 mg; powder for inj 40 mg SE: Chest pain, anxiety, GI upset Interactions: ↑ Ef- fects OF warfarin; ↑ effects of photosensitivity W/ St. John’s wort; ↓ effects OF ketoconazole Labs:↑ Serum glucose, lipids, LFTs; monitor PT, INR NIPE: N Sun exposure—use sunscreen; take w/o regard to food; antacids will not effect drug absorption Paregoric [Camphorated Tincture of Opium] [C-III] [Narcotic Antidiarrheal] Uses: *D*, Pain & neonatal opiate withdrawal synd Action: Narcotic Dose: Adults. 5–10 mL PO daily–qid PRN. Peds. 0.25–0.5 mL/kg daily–qid. Neonatal withdrawal: 3–6 gtt PO q3–6 h PRN to relieve Sxs × 3–5 d, then taper over 2–4 wk Caution: [B (D w/ prolonged use/high dose near term, +] Contra: Toxic diarrhea; convulsive disorder Disp: Liq 2 mg morphine = 20 mg opium/5 mL SE: ↓ BP, sedation, constipation Interactions: ↓ Effects OF ampicillin esters, azole antifungals, Fe salts Labs: ↑ LFTs, SCr NIPE: Take w/o regard to food; contains anhydrous morphine from opium; short-term use only Paroxetine (Paxil, Paxil CR) [Antidepressant/SSRI] WARN- ING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression, OCD, panic disorder, social anxiety disorder*, PMDD Action: SSRI Dose: 10–60 mg PO single daily dose in AM; CR 25 mg/d PO; ↑ 12.5 mg/wk (max range 26–62.5 mg/d) Caution: [D, ?/] Contra: MAOI Disp: Tabs 10, 20, 30, 40 mg; susp 10 mg/5 mL; CR 12.5, 25, 37.5 mg SE: Sexual dysfunction, HA, somnolence, dizziness, GI upset, D, xerostomia, tachycardia Interactions: ↑ Effects W/ cimetidine; ↑ effects OF BBs, dexfenfluramine, dextromethorphan, fenfluramine, haloperidol, MAOIs, theophylline, thioridazine, TCAs, warfarin, St. John’s wort, EtOH; ↓ effects W/ cyproheptadine, phenobarbital, phenytoin; ↓ effects OF digoxin, phenytoin Labs: ↑ Alk phosp, bilirubin, glucose NIPE: Take w/o regard to food, may take up to 4 wk for full effect Pegfilgrastim (Neulasta) [Colony Stimulating Factor] Uses: *↓ Frequency of Infxn in pts w/ nonmyeloid malignancies receiving myelosuppressive 222 Peg Interferon Alfa-2a anti-CA drugs that cause febrile neutropenia* Action: Granulocyte and macrophage stimulating factor Dose: Adults. 6 mg SQ × 1/chemo cycle. Peds. 100 μg/kg SQ × 1/chemo cycle Caution: [C, M] In sickle cell Contra: Allergy to E. coli-derived proteins or filgrastim Disp: Syringes: 6 mg/0.6 mL SE: Splenic rupture, HA, fever, weakness, fatigue, dizziness, insomnia, edema, N/V/D, stomatitis, anorexia, constipation, taste perversion, dyspepsia, abd pain, granulocytopenia, neutropenic fever, ↑ LFT & uric acid, arthralgia, myalgia, bone pain, ARDS, alopecia, worsen sickle cell Dz Interactions: ↑ Effects W/ Li Labs: ↑ LFTs, uric acid, alkaline phosphatase, LDH NIPE: N Exposure to Infxn; never give between 14 d before & 24 h after dose of cytotoxic chemo Peg Interferon Alfa-2a (Pegasys) [Antiviral/Immunomodu- lator] WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely Uses: *Chronic Hep C w/ compensated liver Dz* Action: Biologic response modifier Dose: 180 μg (1 mL) SQ qwk × 48 wk; ↓ in renal impair Caution: [C, X if used W/ ribavirin; ?/–] Contra: Autoimmune hepatitis, decompensated liver Dz Disp: 180 μg/mL inj SE: Depression, insomnia, suicidal behavior, GI upset, neutro & thrombocytopenia, alopecia, pruritus Interactions: ↑ Effects OF theophylline; ↑ risk of anemia W/ ribavirin Labs: Monitor CBC; ↑ ALT, triglycerides; ↓ HMG, Hct, plts, WBC NIPE: N Exposure to Infxn; use barrier contraception; may aggravate neuropsychiatric, autoimmune, ischemic, & infectious disorders Peg Interferon Alfa-2b (PEG-Intron) [Antiviral/Immunomod- ulator] WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Monitor patients closely Uses: *Rx Hep C* Action: Immune modulation Dose: 1 μg/kg/wk SQ; 1.5 μg/kg/wk combined w/ ribavirin Caution: [C, X if used W/ ribavirin; ?/–] w/ h/o psychiatric Contra: Autoimmune hepatitis, decompensated liver Dz, hemoglobinopathy Disp: Vials 50, 80, 120, 150 μg/0.5 mL; Redipen 50, 80,120,150 μg/5 mL; reconstitute w/ 0.7 mL w/ sterile water SE: Depression, insomnia, suicidal behavior, GI upset, neutropenia, thrombocytopenia, alopecia, pruritus Interactions: ↑ Myelosuppres- sion W/ antineoplastics; ↑ effects OF doxorubicin, theophylline; ↑ neurotox W/ vinblastine Labs: ↑ ALT, ↓ neutrophils, plts; monitor CBC/plts NIPE: Maintain hydration; use barrier contraception; give hs or w/ APAP to ↓ flulike Sxs; use immediately or store in refrigerator × 24 h; do not freeze Pemetrexed (Alimta) [Antineoplastic/Folate Antagonist] Uses: *w/ cisplatin in nonresectable mesothelioma* NSCLC Action: Antifolate antineoplastic Dose: 500 mg/m2 IV over 10 min every 3 wk; hold if CrCl <45 μ μ mL/min; give w/ vitamin B12 (1000 g IM every 9 wk) & folic acid (350–1000 g PO daily); start 1 wk before; dexamethasone 4 mg PO bid × 3 start 1 d before each Rx Caution: [D, –] w/ renal/hepatic/ BM impair Contra: Component sensitivity Disp: 500-mg vial SE: Neutropenia, thrombocytopenia, N/V/D, anorexia, stomatitis, renal failure, neuropathy, fever, fatigue, mood changes, dyspnea, anaphylactic Penicillin G Benzathine 223

Rxns Interactions:↑ Effects W/ NSAIDs, probenecid due to decreased pemetrexed clearance Labs: ↑ Cr, LFTs; ↓ HMG, Hct; monitor CBC/ plts NIPE: N PRG & lactation; N use NSAIDs 5 d before, during, or 5 d after treatment Pemirolast (Alamast) [Mast Cell Stabilizer] Uses: *Allergic conjunctivitis* Action: Mast cell stabilizer Dose: 1–2 gtt in each eye qid Caution: [C, ?/–] Disp: 0.1% (1 mg/mL) in 10-mL bottles SE: HA, rhinitis, cold/flu Sxs, local irritation NIPE: Wait 10 min before inserting contacts Penbutolol (Levatol) [Antihypertensive/BB] Uses: *HTN*Ac- β β β ↓ tion: -adrenergic receptor blocker, 1, 2 Dose: 20–40 mg/d; in hepatic insuff Caution: [C 1st tri; D if 2nd/3rd tri, M] Contra: Asthma, cardiogenic shock, cardiac failure, heart block, bradycardia, COPD, pulm edema Disp: Tabs 20 mg SE: Flush- ing, ↓ BP, fatigue, hyperglycemia, GI upset, sexual dysfunction, bronchospasm In- teractions: ↑ Effects W/ CCBs, fluoroquinolones; ↑ bradycardia W/ adenosine, amiodarone, digitalis, dipyridamole, epinephrine, neuroleptics, phenylephrine, physostigmine, tacrine; ↑ effects OF lidocaine, verapamil; ↓ effects W/ antacids, NSAIDs; ↓ effects OF insulin, hypoglycemics, theophylline Labs: ↑ Serum glucose, BUN, K+, lipoprotein, triglycerides, uric acid NIPE: ↑ Cold sensitivity Penciclovir (Denavir) [Antiviral] Uses: *Herpes simplex (herpes labi- alis/cold sores)* Action: Competitive inhibitor of DNA polymerase Dose: Apply at 1st sign of lesions, then q2h while awake × 4 d Caution: [B, ?/–] Contra: Allergy, previous Rxn to famciclovir Disp: Cream 1% [OTC] SE: Erythema, HA NIPE: N Recommended in lactation or in children; N apply to mucous membranes or near eyes Penicillin G, Aqueous (Potassium or Sodium) (Pfizerpen, Pentids) [Antibiotic/Penicillin] Uses: *Bacteremia, endocarditis, pericarditis, resp tract Infxns, meningitis, neurosyphilis, skin/skin structure Infxns* Action: Bactericidal; ↓ cell wall synth. Spectrum: Most gram(+) (not staphylococci), streptococci, N. meningitidis, syphilis, clostridia, & anaerobes (not Bac- teroides) Dose: Adults. 400,000–800,000 units PO qid; IV doses vary depending on indications; range 0.6–24 million units/d in ÷ doses q4h. Peds. Newborns <1 wk: 25,000–50,000 units/kg/dose IV q12h. Infants 1 wk–<1 mo: 25,000–50,000 units/kg/dose IV q8h. Children: 100,000–300,000 units/kg/24h IV ÷ q4h; ↓ in renal impair Caution: [B, M] Contra: Allergy Disp: Tabs 200,000, 250,000, 400,000, 800,000 units; susp 200,000, 400,000 units/5 mL; powder for inj SE: Allergic Rxns; interstitial nephritis, D, Szs Notes: Contains 1.7 mEq of K+/million units Interac- tions: ↑ Effects W/ probenecid; ↑ effects OF MTX; ↑ risk of bleeding W/ anticoagulants; ↓ effects W/ chloramphenicol, macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ K+, eosinophils; ↓ serum albumin NIPE: Monitor for super Infxn; use barrier contraception Penicillin G Benzathine (Bicillin) [Antibiotic/Penicillin] Uses: *Single-dose regimen for streptococcal pharyngitis, rheumatic fever, glomeru- lonephritis prophylaxis, & syphilis* Action: Bactericidal; ↓ cell wall synth. 224 Penicillin G Procaine

Spectrum: See Penicillin G Dose: Adults. 1.2–2.4 million units deep IM inj q2–4wk. Peds. 50,000 units/kg/dose, 2.4 million units/dose max; deep IM inj q2–4 wk Caution: [B, M] Contra: Allergy Disp: Inj 300,000, 600,000 units/mL; Bi- cillin L-A benzathine salt only; Bicillin C-R combo of benzathine & procaine (300,000 units procaine w/ 300,000 units benzathine/mL or 900,000 units benzathine w/ 300,000 units procaine/2 mL) SE: Inj site pain, acute interstitial nephritis, anaphylaxis Interactions: ↑ Effects W/ probenecid; ↑ penicillin 1/2 life W/ ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics; ↑ risk of bleeding W/ anticoagulants; ↓ effects W/ chloramphenicol, macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ Eosinophils; ↓ serum albumin NIPE: Monitor for super Infxn; use barrier contraception; sustained action, detectable levels up to 4 wk; drug of choice for noncongenital syphilis Penicillin G Procaine (Wycillin, Others) [Antibiotic/Peni- cillin] Uses: *Infxns of respir tract, skin/soft tissue, scarlet fever, syphilis*Ac- tion: Bactericidal; ↓ cell wall synth. Spectrum: PCN G-sensitive organisms that respond to low, persistent serum levels Dose: Adults. 0.6–4.8 million units/d in ÷ doses q12–24h; give probenecid at least 30 min prior to PCN to prolong action. Peds. 25,000–50,000 units/kg/d IM ÷ daily–bid Caution: [B, M] Contra: Allergy Disp: Inj 300,000, 500,000, 600,000 units/mL SE: Pain at inj site, interstitial nephritis, anaphylaxis Interactions: ↑ Effects W/ probenecid; ↑ penicillin 1/2 life W/ ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics; ↑ risk of bleeding W/ anticoagulants; ↓ effects W/ chloramphenicol, macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ Eosinophils; ↓ serum albumin NIPE: Monitor for super Infxn; use barrier contraception; LA parenteral PCN; levels up to 15 h Penicillin V (Pen-Vee K, Veetids, Others) [Antibiotic/Peni- cillin] Uses: Susceptible streptococci Infxns, otitis media, URIs, skin/soft tissue Infxns (PCN-sensitive staph) Action: Bactericidal; ↓ cell wall synth. Spectrum: Most gram(+), including strep Dose: Adults. 250–500 mg PO q6h, q8h, q12h. Peds. 25–50 mg/kg/25h PO in 4 doses; ↓ in renal impair; on empty stomach Cau- tion: [B, M] Contra: Allergy Disp: Tabs 125, 250, 500 mg; susp 125, 250 mg/5 mL SE: GI upset, interstitial nephritis, anaphylaxis, convulsions Interactions: ↑ Effects W/ ASA, probenecid; ↑ effects OF MTX; ↑ risk of anaphylaxes W/ BB; ↓ effects W/ chloramphenicol, macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ Eosinophils; ↓ serum albumin, WBC NIPE: Monitor for super Infxn; use barrier contraception; well-tolerated PO PCN; 250 mg = 400,000 units of PCN G Pentamidine (Pentam 300, NebuPent) [Antiprotozoal] Uses: *Rx & prevention of PCP* Action: ↓ DNA, RNA, phospholipid, & protein synth Dose: Rx: Adults & Peds. 4 mg/kg/24 h IV daily for 14–21 d. Prevention: Adults & Peds >5 y. 300 mg once q4wk, give via Respirgard II neb; ↓ w/ IV in renal impair Caution: [C, ?] Contra: Component allergy, use w/ didanosine Disp: Inj 300 mg/vial; aerosol 300 mg SE: Pancreatic cell necrosis w/ hyperglycemia; pancreatitis, CP, fatigue, dizziness, rash, GI upset, renal impair, blood dyscrasias Pentoxifylline 225

(leukopenia & thrombocytopenia) Interactions: ↑ Nephrotoxic effects W/ aminoglycosides, amphotericin B, capreomycin, cidofovir, cisplatin, cyclosporine, colistin, ganciclovir, methoxyflurane, polymyxin B, vancomycin; ↑ BM suppression W/ antineoplastics, radiation therapy Labs: ↑ LFTs, serum K+, ↓ HMG, Hct, plts, WBCs; ↑ or ↓ glucose; monitor glucose and CBC NIPE: Reconstitute W/ sterile ↑ H2O only, inhalation may cause metallic taste; fluids to 2–3 L/d; monitor pancreatic Fxn monthly for 1st 3 mo; monitor for ↓ BP following IV dose Pentazocine (Talwin, Talwin Compound, Talwin NX) [C-IV] [Narcotic Analgesic] Uses: *Moderate–severe pain* Action: Partial narcotic agonist–antagonist Dose: Adults. 30 mg IM or IV; 50–100 mg PO q3–4h PRN. Peds. 5–8 y: 15 mg IM q4h PRN. 8–14 y: 30 mg IM q4h PRN; ↓ in renal/hepatic impair Caution: [C (1st tri, D w/ prolonged use/high dose near term), +/–] Contra: Allergy, ↑ ICP (unless ventilated) Disp: Talwin compound tab 12.5 mg + 325 mg ASA; Talwin NX 50 mg + 0.5 mg naloxone; inj 30 mg/mL SE: Consider- able dysphoria; drowsiness, GI upset, xerostomia, Szs Notes: 30–60 mg IM = 10 mg of morphine IM Interactions: ↑ CNS depression W/ antihistamines, barbiturates, hypnotics, phenothiazine, EtOH; ↑ effects W/ cimetidine; ↑ effects OF digitoxin, phenytoin, rifampin; ↓ effects OF opioids Labs: ↑ Serum amylase, lipase NIPE: May cause withdrawal in pts using opioids; Talwin NX has naloxone to curb abuse by non-oral route. Pentobarbital (Nembutal, others) [C-II] [Anticonvulsant, Sedative/Hypnotic/Barbiturate] Uses: *Insomnia, convulsions*, induce coma following severe head injury Action: Barbiturate Dose: Adults. Seda- tive: 20–40 mg PO or PR q6–12h. Hypnotic: 100–200 mg PO or PR hs PRN. Induced coma: Load 5–10 mg/kg IV, then maint 1–3 mg/kg/h IV inf to maint burst suppression on EEG. Peds. Hypnotic: 2–6 mg/kg/dose PO hs PRN. Induced coma: As adult Caution: [D, +/–] Severe hepatic impair Contra: Allergy Disp: Caps 50, 100 mg; elixir 18.2 mg/5 mL (= 20 mg pentobarbital); supp 30, 60, 120, 200 mg; inj 50 mg/mL SE: Resp depression, ↓ BP w/ aggressive IV use for cerebral edema; bradycardia, ↓ BP, sedation, lethargy, resp ↓, hangover, rash, Stevens–Johnson synd, blood dyscrasias Interactions: ↑ Effects W/ MAOIs, narcotic analgesics, EtOH; ↓ effects OF anticoagulants, BBs, corticosteroids, cyclosporine, digoxin, doxycycline, griseofulvin, neuroleptics, OCPs, quinidine, theophylline, verapamil NIPE: Tolerance to sedative–hypnotic effect w/in 1–2 wk Pentosan Polysulfate Sodium (Elmiron) [Urinary Analgesic] Uses: *Relieve pain/discomfort w/ interstitial cystitis* Action: Bladder wall buffer Dose: 100 mg PO tid; on empty stomach w/ H2O 1 h ac or 2 h pc Caution: [B, ?/–] Contra: Allergy Disp: Caps 100 mg SE: Alopecia, N/D, HA, thrombocytopenia Interactions: Risk of ↑ anticoagulation W/ anticoagulants, ASA, thrombolytics Labs: ↑ LFTs NIPE: Reassess after 3 mo Pentoxifylline (Trental) [Hemorheologic/Xanthine Derivative] Uses: *Rx symptoms of peripheral vascular Dz* Action: ↓ Blood cell viscosity, 226 Perindopril Erbumine restores RBC flexibility Dose: Adults. 400 mg PO tid pc; Rx min 8 wk for effect; ↓ to bid w/ GI/CNS SEs Caution: [C, +/–] Contra: Cerebral/retinal hemorrhage Disp: Tabs CR 400 mg; Tabs XR 400 mg SE: Dizziness, HA, GI upset Interac- tions: ↑ Risk of bleeding W/ anticoagulants, NSAIDs; ↑ effects OF antihypertensives, theophylline NIPE: Take W/ food to < GI upset Perindopril Erbumine (Aceon) [Antihypertensive/ACEI] Uses: *HTN*, CHF, DN, post-MI Action: ACE inhibitor Dose: 4–8 mg/d;16 mg/day max; avoid w/ food; ↓ in elderly/renal impair Caution: [C (1st tri, D 2nd & 3rd tri), ?/–] ACE-inhibitor-induced angioedema Contra: Bilateral RAS, primary hyperaldosteronism Disp: Tabs 2, 4, 8 mg SE: HA, ↓ BP, dizziness, GI upset, cough Interactions: ↑ Effects W/ antihypertensives, diuretics; ↑ effects OF cyclosporine, insulin, Li, sulfonylureas, tacrolimus; ↓ effects W/ NSAIDs Labs: ↑ Serum K+, LFTs, uric acid, cholesterol, Cr NIPE: ↓ Effects if taken W/ food; risk of persistent cough; OK W/ diuretics Permethrin (Nix, Elimite) [OTC] [Scabicides/Pediculicides] Uses: *Rx lice/scabies* Action: Pediculicide Dose: Adults & Peds. Lice: Saturate hair & scalp; allow 10 min before rinsing; Scabies: Apply cream head to toe; leave for 8–14 hours, wash w/ H2O Caution: [B, ?/–] Contra: Allergy Disp: Topical lotion 1%; cream 5% SE: Local irritation NIPE: Drug remains on hair up to 2 wk, reapply in 1 wk if live lice; disinfect clothing, bedding, combs, & brushes, lotion not OK in peds <2 y, may repeat after 7 d Perphenazine (Trilafon) [Antipsychotic, Antiemetic/Phe- nothiazine] Uses: *Psychotic disorders, severe N*, intractable hiccups Ac- tion: Phenothiazine, blocks brain dopaminergic receptors Dose: Adults: Antipsychotic: 4–16 mg PO tid; max 64 mg/d. Hiccups: 5 mg IM q6h PRN or 1 mg IV at intervals not <1–2 mg/min, 5 mg max. Peds. 1–6 y: 4–6 mg/d PO in ÷ doses. 6–12 y: 6 mg/d PO in ÷ doses. >12 y: 4–16 mg PO bid–qid; ↓ in hepatic insuff Caution: [C, ?/–] NAG, severe ↑/↓ BP Contra: Phenothiazine sensitivity, BM depression, severe liver or cardiac Dz Disp: Tabs 2, 4, 8, 16 mg; PO conc 16 mg/ 5 mL; inj 5 mg/mL SE: ↓ BP, tachycardia, bradycardia, EPS, drowsiness, Szs, photosens, skin discoloration, blood dyscrasias, constipation Interactions: ↑ Ef- fects W/ antidepressants; ↑ effects OF anticholinergics, antidepressants, propranolol, phenytoin; ↑ CNS effects W/ CNS depressants, EtOH; ↓ effects W/ antacids, Li, phenobarbital, caffeine, tobacco; ↓ effects OF levodopa, Li Labs: ↑ Serum cholesterol, glucose, LFTs; ↓ HMG, plts, WBCs NIPE: Take oral dose W/ food; risk of photosensitivity—use sunscreen Phenazopyridine (Pyridium, Others) [Urinary Analgesic] Uses: *Lower urinary tract irritation* Action: Local anesthetic on urinary tract mucosa Dose: Adults. 100–200 mg PO tid. Peds 6–12 y. 12 mg/kg/24 h PO in 3 ÷ doses; ↓ in renal insuff Caution: [B, ?] Hepatic Dz Contra: Renal failure Disp: Tabs 95, 97.2, 100, 200 mg SE: GI disturbances; red-orange urine color (can stain clothing); HA, dizziness, acute renal failure, methemoglobinemia Labs: Interferes Phenylephrine, nasal 227

W/ urinary tests for glucose, ketones, bilirubin, protein, steroids NIPE: Urine may turn red-orange in color and can stain clothing; take pc Phenelzine (Nardil) [Antidepressant/MAOI] WARNING: Anti- depressants increase the risk of suicidal thinking and behavior in children and adolescents w/ major depressive disorder and other psychiatric disorders Uses: *Depression* Action: MAOI Dose: 15 mg PO tid. Elderly: 15–60 mg/d ÷ doses Caution: [C, –] Interacts w/ SSRI, ergots, triptans Contra: CHF, h/o liver Dz, pheochromocytoma Disp: Tabs 15 mg SE: Postural ↓ BP; edema, dizziness, sedation, rash, sexual dysfunction, xerostomia, constipation, urinary retention Interac- tions: ↑ HTN Rxn W/ amphetamines, fluoxetine, levodopa, metaraminol, phenylephrine, phenylpropanolamine, pseudoephedrine, reserpine, sertraline, tyramine, EtOH, foods W/ tyramine, caffeine, tryptophan; ↑ effects OF barbiturates, narcotics, sedatives, sumatriptan, TCAs, ephedra, ginseng Labs: ↓ Glucose, false + ↑ in bilirubin & uric acid NIPE: May take 2–4 wk for effect; avoid tyramine- containing foods (eg, cheeses) Phenobarbital [C-IV] [Anticonvulsant, Sedative/ Hyp- notic/Barbiturate] Uses: *Sz disorders*, insomnia, anxiety Action: Barbi- turate Dose: Adults. Sedative–hypnotic: 30–120 mg/d PO or IM PRN. Anticonvulsant: Load 10–12 mg/kg in 3 ÷ doses, then 1–3 mg/kg/24 h PO, IM, or IV. Peds. Sedative–hypnotic: 2–3 mg/kg/24 h PO or IM hs PRN. Anticonvulsant: Load 15–20 mg/kg ÷ in 2 equal doses 4 h apart, then 3–5 mg/kg/24h PO ÷ in 2–3 doses; ↓ w/ CrCl <10 Caution: [D, M] Contra: Porphyria, hepatic impair, dyspnea, airway obst Disp: Tabs 15, 16, 30, 32, 60, 65, 100 mg; elixir 15, 20 mg/5 mL; inj 30, 60, 65, 130 mg/mL SE: Bradycardia, ↓ BP, hangover, Stevens–Johnson synd, blood dyscrasias, resp depression Notes: Levels: Trough: Just before next dose; Therapeutic: Peak: 15–40 μg/mL; Toxic: Trough: >40 μg/mL; 1/2 life: 40–120h Interactions: ↑ CNS depression W/ CNS depressants, anesthetics, antianxiety meds, antihistamines, narcotic analgesics, EtOH, Indian snakeroot, kava kava; ↑ effects W/ chloramphenicol, MAOIs, procarbazine, valproic acid; ↓ effects W/ rifampin; ↓ effects OF anticoagulants, BBs, carbamazepine, clozapine, corticosteroids, doxorubicin, doxycycline, estrogens, felodipine, griseofulvin, haloperidol, methadone, metronidazole, OCPs, phenothiazine, quinidine, TCAs, theophylline, verapamil Labs: ↓ Bilirubin NIPE: May take 2–3 wk for full effects; N D/C abruptly; tolerance develops to sedation; paradoxic hyperactivity seen in ped pts; long 1/2-life allows single daily dosing Phenylephrine, nasal (Neo-Synephrine Nasal) (OTC) [Vaso- pressor/Decongestant] Uses: *Nasal congestion* Action: α-Adrenergic agonist Dose: Adults. 1–2 sprays/nostril q4h (usual 0.25%) PRN. Peds. 6 mo–2 y: 0.125% 1–2 drops/nostril q3–4h, 2–6 y: 0.125% 2–3 drops/nostril q3–4h, 6–12 y: 1–2 sprays/nostril q4h 0.25% 2–3 drops Caution: [C, +/–] HTN, acute pancreatitis, hepatitis, coronary Dz, NAG, hyperthyroidism Contra: Bradycardia, arrhythmias Disp: Nasal soln 0.125, 0.25, 0.5, 1%; Liq 7.5 mg/5 mL; drops 2.5 mg/mL 228 Phenylephrine, Ophthalmic

SE: Arrhythmias, HTN, nasal irritation, dryness, sneezing, rebound congestion w/ prolonged use, HA NIPE: Do not use >3 d Phenylephrine, Ophthalmic (Neo-Synephrine Ophthalmic, AK-Dilate, Zincfrin [OTC]) [Vasopressor/Decongestant] Uses: * Mydriasis, ocular redness [OTC], periop mydriasis, posterior synechiae, uveitis w/ posterior synechiae* Action: α-Adrenergic agonist Dose: Adults. Red- ness: 1 gtt 0.12% q3–4h PRN; Exam mydriasis: 1 gtt 2.5% (15 min–1 h for effect); Preop: 1 gtt 2.5–10% 30–60 min preop; Ocular disorders: 1 gtt 2.5–10% daily–tid Peds. As adult, only use 2.5% for exam, preop, and ocular conditions Caution: [C (may cause late-term fetal anoxia/bradycardia), +/–] HTN, w/ elderly w/ CAD, Contra: NAG Disp: Ophth soln 0.12% (Zincfrin OTC), 2.5, 10%; SE: Tearing, HA, irritation, eye pain, photophobia, arrhythmia, tremor Phenylephrine, Oral (Sudafed PE, SudoGest PE, Nasop, Lu- sonal, AH-chew D, Sudafed PE quick dissolve) (OTC) [Vaso- pressor/Decongestant] WARNING: Prescribers should be aware of full prescribing info before use Uses: *Nasal congestion* Action: α-Adrenergic agonist Dose: Adults. 10–20 mg PO q4h PRN, max 60 mg/d Peds. 5 mg PO q4h PRN, max 60 mg/d Caution: [C, +/–] HTN, acute pancreatitis, hepatitis, coronary Dz, NAG, hyperthyroidism Contra: MAOI w/in 14 d, NAG, severe ↑ BP or CAD, urinary retention Disp: Liq 7.5 mg/5 mL; drops 2.5 mg/mL; tabs 5, 10 mg; chew tabs 10 mg; tabs OD 10 mg; strips 10 mg. SE: Arrhythmias, HTN, HA, agitation, anxiety, tremor, palpitations Interactions: ↑ Risk of HTN crisis W/ MAOIs; ↑ risk of pressor effects W/ BB; ↑ risk of arrhythmias W/epinephrine, isoproterenol; ↓ effects OF guanethidine, methyldopa, reserpine Phenylephrine, Systemic (Neo-Synephrine) [Vasopressor/ Adrenergic] WARNING: Prescribers should be aware of full prescribing info before use Uses: *Vascular failure in shock, allergy, or drug-induced ↓ BP* Action: α-Adrenergic agonist Dose: Adults. Mild–moderate ↓ BP: 2–5 mg IM or SQ ↑ BP for 2 h; 0.1–0.5 mg IV ↑ BP for 15 min. Severe ↓ BP/shock: Cont inf at 100–180 μg/min; after BP stable, maint 40–60 μg/min Peds. ↓ BP: 5–20 μg/kg/dose IV q10–15 min or 0.1–0.5 μg/kg/min IV inf, titrate to effect. Caution: [C, +/–] HTN, acute pancreatitis, hepatitis, coronary Dz, NAG, hyperthyroidism Contra: Bradycardia, arrhythmias Disp: Inj 10 mg/mL SE: Arrhythmias, HTN, peripheral vasoconstriction ↑ w/ oxytocin, MAOIs, & TCAs; HA, weakness, necrosis, ↓ renal perfusion Interactions: ↑ HTN W/ BBs, MAOIs; ↑ pressor response W/ guanethidine, methyldopa, reserpine, TCAs; NIPE: Restore blood volume if loss has occurred; use large veins to avoid extrav; phentolamine 10 mg in 10–15 mL of NS for local inj to Rx extrav Phenytoin (Dilantin) [Anticonvulsant/Hydantoin] Uses: *Sz disorders* Action: ↓ Sz spread in the motor cortex Dose: Load: Adults & Peds. 15–20 mg/kg IV, 25 mg/min max or PO in 400-mg doses at 4-h intervals. Maint: Adults. Initial, 200 mg PO or IV bid or 300 mg hs; then follow levels. Peds. Pimecrolimus 229

4–7 mg/kg/24h PO or IV ÷ daily–bid; avoid PO susp (erratic absorption) Caution: [D, +] Contra: Heart block, sinus bradycardia Disp: Dilatin Infatab chew 50 mg; Dilantin/Phenytek caps 100 mg; caps, XR 30, 100, 200, 300 mg; susp 125 mg/ 5 mL; inj 50 mg/mL SE: Nystagmus/ataxia early signs of tox; gum hyperplasia w/ long-term use. IV: ↓ BP, bradycardia, arrhythmias, phlebitis; peripheral neuropathy, rash, blood dyscrasias, Stevens–Johnson synd Notes: Levels: Trough: Just before next dose; Therapeutic: Peak: 10–20 μg/mL; Toxic: >20 μg/mL; Phenytoin albumin bound, levels = bound & free phenytoin; w/ ↓ albumin & azotemia, low levels may be therapeutic (nl free levels) Interactions: ↑ Effects W/ amiodarone, allopurinol, chloramphenicol, disulfiram, INH, omeprazole, sulfonamides, quinolones, trimethoprim; ↑ effects OF Li; ↓ effects W/ cimetidine, cisplatin, diazoxide, folate, pyridoxine, rifampin; ↓ effects OF azole antifungals, benzodiazepines, carbamazepine, corticosteroids, cyclosporine, digitalis glycosides, doxycycline, furosemide, levodopa, OCPs, quinidine, tacrolimus, theophylline, thyroid meds, valproic acid Labs: ↑ Serum cholesterol, glucose, alkaline phosphatase NIPE: Take w/ food; may alter urine color; use barrier contraception; N D/C abruptly; do not change dosage at intervals <7–10 d, hold tube feeds 1 h before and after dose if using oral susp Physostigmine (Antilirium) [Antimuscarinic Antidote/Re- versible Cholinesterase Inhibitor] Uses: *Antidote for TCA, atropine, & scopolamine OD; glaucoma* Action: Reversible cholinesterase inhibitor Dose: Adults. 0.5–2 mg IV or IM q20min. Peds. 0.01–0.03 mg/kg/dose IV q15–30min up to 2 mg total if needed Caution: [C, ?] Contra: GI/GU obst, CV Dz Disp: Inj 1 mg/mL SE: Rapid IV admin associated w/ Szs; cholinergic SE; sweating, salivation, lacrimation, GI upset, asystole, changes in HR Interactions: ↑ Resp depression W/ succinylcholine, ↑ effects W/ cholinergics, jaborandi tree, pill-bearing spurge Labs: ↑ ALT, AST, serum amylase; excessive readministration can result in cholinergic crisis; crisis reversed W/ atropine Phytonadione [Vitamin K] (AquaMEPHYTON, Others) [Blood Modifier/Vitamin K] Uses: *Coagulation disorders due to faulty formation of factors II, VII, IX, X*; hyperalimentation Action: Cofactor for production of factors II, VII, IX, & X Dose: Adults & Children. Anticoagulant- induced prothrombin deficiency: 1–10 mg PO or IV slowly. Hyperalimentation: 10 mg IM or IV qwk. Infants. 0.5–1 mg/dose IM, SQ, or PO Caution: [C, +] Contra: Allergy Disp: Tabs 5 mg; inj 2, 10 mg/mL SE: Anaphylaxis from IV dosage; give IV slowly; GI upset (PO), inj site Rxns Interactions: ↓ Effects W/ antibiotics, cholestyramine, colestipol, salicylates, sucralfate; ↓ effects OF oral anticoagulants Labs: Falsely ↑ urine steroids NIPE: W/ parenteral Rx, 1st change in pt usually seen in 12–24 h; use makes recoumadinization more difficult Pimecrolimus (Elidel) [Topical Immunomodulator] WARN- ING: Associated with rare skin malignancies and lymphoma, limit to area, not for age <2 y Uses: *Atopic dermatitis* refractory, severe perianal itching Action: 230 Pindolol

Inhibits T-lymphocytes Dose: Adult and Peds >2 y: Apply bid; use at least 1 wk following resoln Caution: [C, ?/–] w/ local Infxn, lymphadenopathy; immunocom- promise; avoid <2 y of age Contra: Allergy component, <2 y Disp: Cream 1% SE: Phototox, local irritation/burning, flulike Sxs, may ↑ malignancy NIPE: Apply to dry skin only; wash hands after use; theoretical CA risk; 2nd line/short- term use only Pindolol (Visken) [Antihypertensive/BB] Uses: *HTN* Action: β β β ↓ -Adrenergic receptor blocker, 1, 2, ISA Dose: 5–10 mg bid, 60 mg/d max; in hepatic/renal failure Caution: [B (1st tri; D if 2nd or 3rd tri), +/–] Contra: Un- compensated CHF, cardiogenic shock, bradycardia, heart block, asthma, COPD Disp: Tabs 5, 10 mg SE: Insomnia, dizziness, fatigue, edema, GI upset, dyspnea; fluid retention may exacerbate CHF Interactions: ↑ HTN & bradycardia W/ amphetamines, ephedrine, phenylephrine; ↑ Effects W/ antihypertensives, diuretics; ↓ effects W/ NSAIDs; ↓ effect OF hypoglycemics Labs: ↑ LFTs, uric acid NIPE: N D/C abruptly; ↑ cold sensitivity Pioglitazone HCL/Glimepiride (Duetact) [Hypoglycemic/Thi- azolidinedione & Sulfonylurea] Uses: Type 2 DM as adjunct to diet and exercise Action: Combined ↑ insulin resistance, ↑ pancreatic insulin secretion, ↓ hepatic glucose output and production Dose: Initially 1 tab PO OD with the 1st main meal Caution: [C, –] Contra: Hepatic impair, DKA Disp: Tabs pioglitazone HCL/glimepiride: 30 mg/2mg, 30 mg/4 mg SE: ↑ Risk of CV mortality, hypoglycemia, wt gain, HA, edema, N, URI Interactions: ↑ Effects W/ ASA, BB, chloramphenicol, ketoconazole, MAOIs, NSAIDs, probenecid, salicylates, sulfonamides, ↓ effects W/ corticosteroids, diuretics, estrogens, isoniazid, phenothiazine, phenytoin, sympathomimetics, thyroid drugs ↓ effects OF OCPs Labs: ↑ LFTs, ↓ HMG, Hct NIPE: Take w/ 1st main meal of the day; use barrier contraception; N use in type 1 DM Pioglitazone/Metformin (ActoPlus Met) [Hypoglycemic/Thi- azolidinedione & Biguanide] WARNING: Can cause lactic acidosis, which is fatal in 50% of cases Uses: *Type 2 DM as adjunct to diet and exercise* Action: Combined ↑ insulin sensitivity w/ ↓ hepatic glucose release Dose: Initial 1 tab PO daily or bid, titrate; max daily pioglitazone 45 mg & metformin 2550 mg Caution: [C, –] Stop w/ radiologic contrast agents Contra: Renal impair, acidosis Disp: Tabs pioglitazone mg/metformin mg: 15/500, 15/850 SE: Lactic acidosis, hypoglycemia, edema, wt gain, URI, HA, GI upset, liver damage Interactions: ↑ Effects W/ amiloride, cimetidine, digoxin, furosemide, ketoconazole, MAOIs, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin; ↓ effects OF OCPs; ↓ effects W/ corticosteroids, CCBs, diuretics, estrogens, INH, OCPs, phenothiazine, phenytoin, sympathomimetics, thyroid drugs, tobacco Labs: ↑ LFTs, ↓ HMG, Hct; monitor serum glucose NIPE: Take w/o regard to food; use barrier contraception; N dehydration, EtOH; ↑ fracture risk in women receiving pioglitazone Piroxicam 231

Pioglitazone (Actos) [Hypoglycemic/Thiazolidinedione] Uses: *Type 2 DM* Action: ↑ Insulin sensitivity Dose: 15–45 mg/d PO Caution: [C, –] Contra: Hepatic impair Disp: Tabs 15, 30, 45 mg SE: Wt gain, URI, HA, hypoglycemia, edema Interactions: ↑ Effects W/ ketoconazole; ↓ effects OF OCPs Labs: ↑ LFTs, ↓ HMG, Hct NIPE: Take w/o regard to food; use barrier contraception; ↑ fracture risk in women Piperacillin (Pipracil) [Antibiotic/Penicillin-4th Generation] Uses: *Infxns of skin, bone, resp &, urinary tract, abdomen, sepsis* Action: 4th- gen PCN; bactericidal; ↓ cell wall synth. Spectrum: Primarily gram(+), better En- terococcus sp, H. influenza, not Staphylococcus sp; gram(–) E. coli, Proteus sp, Shigella sp, Pseudomonas sp, not β-lactamase-producing Dose: Adults. 2–4 g IV q4–6h. Peds. 200–300 mg/kg/d IV ÷ q4–6h; ↓ in renal failure Caution: [B, M] Contra: PCN sensitivity Disp: Powder for inj: 2, 3, 4, 40 g SE: ↓ Plt aggregation, interstitial nephritis, renal failure, anaphylaxis, hemolytic anemia Interactions: ↑ Effects W/ probenecid; ↑ effects OF anticoagulants, MTX; ↓ effects W/ macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ LFTs, BUN, Cr, + direct Coombs test, ↓ K+ NIPE: Inactivation of aminoglycosides if drugs given together— admin at least 1 h apart; often used w/ aminoglycoside Piperacillin–Tazobactam (Zosyn) [Antibiotic/Extended Spec- trum Penicillin, Beta-Lactamase Inhibitor] Uses: *Infxns of skin, bone, resp & urinary tract, abdomen, sepsis * Action: PCN plus β-lactamase inhibitor; bactericidal; ↓ cell wall synth. Spectrum: Good gram(+), excellent gram(–);anaerobes & β-lactamase producers Dose: Adults. 3.375–4.5 g IV q6h; ↓ in renal insuff Cau- tion: [B, M] Contra: PCN or β-lactam sensitivity Disp: Powder for inj: frozen, premix inj 3.25, 3.375, 4.5 g SE: D, HA, insomnia, GI upset, serum sickness-like Rxn, pseudomembranous colitis Interactions: ↑ Effects W/ probenecid; ↑ effects OF anticoagulants, MTX; ↓ effects W/ macrolides, tetracyclines; ↓ effects OF OCPs Labs: ↑ LFTs, BUN, Cr, + direct Coombs test, ↓ K+ NIPE: Inactivation of aminoglycosides if drugs given together—admin at least 1 h apart; often used w/ aminoglycoside Pirbuterol (Maxair) [Bronchodilator/Sympathomimetic] β Uses: *Prevention & Rx reversible bronchospasm* Action: 2-Adrenergic agonist Dose: 2 inhal q4–6h; max 12 inhal/d Caution: [C, ?/–] Disp: Aerosol 0.2 mg/actuation SE: Nervousness, restlessness, trembling, HA, taste changes, tachycardia In- teractions: ↑ Effects W/ epinephrine, sympathomimetics; ↑ vascular effects W/ MAOIs, TCAs; ↓ effects W/ BBs NIPE: Rinse mouth after use; shake well before use; teach patient proper inhaler technique; Piroxicam (Feldene) [Bronchodilator/Beta-Adrenergic Agonist] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose: 10–20 mg/d Caution: [B (1st tri; D if 3rd tri or near term), +] GI bleeding Contra: ASA/NSAID sensitivity Disp: Caps 10, 20 mg SE: Dizziness, rash, GI upset, edema, acute renal failure, peptic ulcer Interactions: ↑ Effects W/ probenecid; ↑ effects OF aminoglycosides, 232 Plasma Protein Fraction anticoagulants, hypoglycemics, Li, MTX; ↑ risk of bleeding W/ ASA, corticosteroids, NSAIDs, feverfew, garlic, ginger, ginkgo biloba, EtOH; ↓ effect W/ ASA, antacids, cholestyramine; ↓ effect OF BBs, diuretics Labs: ↑ BUN, Cr, LFTs NIPE: Take w/food, full effect after 2 wk admin, ↑ risk of photosensitivity—use sunscreen Plasma Protein Fraction (Plasmanate, Others) [Plasma Volume Expander] Uses: *Shock & ↓ BP* Action: Plasma volume expander Dose: Initial, 250–500 mL IV (not >10 mL/min); subsequent inf based on response. Peds. 10–15 mL/kg/dose IV; subsequent inf based on response Caution: [C, +] Contra: Renal insuff, CHF Disp: Inj 5% SE: ↓ BP w/ rapid inf; hypocoagulability, metabolic acidosis, PE NIPE: 130–160 mEq Na/L; not substitute for RBC Pneumococcal 7-Valent Conjugate Vaccine (Prevnar) [Vaccine] Uses: *Immunization against pneumococcal Infxns in infants & children* Action: Active immunization Dose: 0.5 mL IM/dose; series of 3 doses; 1st dose age 2 mo; then doses q2mo, 4th dose at age 12–15 mo Caution: [C, +] Thrombocytopenia Contra: Diphtheria toxoid sensitivity, febrile illness Disp: Inj SE: Local Rxns, arthralgia, fever, myalgia Pneumococcal Vaccine, Polyvalent (Pneumovax-23) [Vaccine/ Inactive Bacteria] Uses: *Immunization against pneumococcal Infxns in pts at high risk (eg, all = 65 y of age)* Action: Active immunization Dose: 0.5 mL IM. Caution: [C, ?] Contra: Do not vaccinate during immunosuppressive therapy Disp: Inj 0.5 mL SE: Fever, inj site Rxn, hemolytic anemia, thrombocytopenia, anaphylaxis Interactions: ↓ Effects W/ corticosteroids, immunosuppressants Podophyllin (Podocon-25, Condylox Gel 0.5%, Condylox) [Antimitotic Effect] Uses: *Topical therapy of benign growths (genital & perianal warts [condylomata acuminata]*, papillomas, fibromas) Action: Direct antimitotic effect; exact mechanism unknown Dose: Condylox gel & Condylox: Apply bid for 3 consecutive d/wk for 4 wk; 0.5 mL/d max; Podocon-25: Use sparingly on the lesion, leave on for 1–4 h, thoroughly wash off Caution: [X, ?] Immuno- suppression Contra: DM, bleeding lesions Disp: Podocon-25 (w/ benzoin) 15-mL bottles; Condylox gel 0.5% 35 g clear gel; Condylox soln 0.5% 35 g clear SE: Local Rxns, significant absorption; anemias, tachycardia, paresthesias, GI upset, renal/hepatic damage NIPE: Podocon-25 applied by the clinician; do not dispense directly to patient; N use on warts on mucous membranes; N use near eyes Polyethylene Glycol [PEG]-Electrolyte Soln (GoLYTELY, CoLyte) [Laxative] Uses: *Bowel prep prior to examination or surgery* Action: Os- motic cathartic Dose: Adults. Following 3–4-h fast, drink 240 mL of soln q10min until 4 L consumed or until BMs are clear. Peds. 25–40 mL/kg/h for 4–10 h Cau- tion: [C, ?] Contra: GI obst, bowel perforation, megacolon, ulcerative colitis Disp: Powder for recons to 4 L SE: Cramping or N, bloating Interactions: Drugs taken within 1 h of polyethylene glycol administration may not be absorbed NIPE: Instruct pt to drink solution rapidly q10min until finished; 1st BM should occur in approximately 1 h; chilled soln more palatable Potassium Iodide 233

Polyethylene Glycol [PEG] 3350 (MiraLax) [Laxative] Uses: *Occasional constipation* Action: Osmotic laxative Dose: 17 g powder (1 heap- ing Tbsp) in 8 oz (1 cup) of H2O & drink; max 14 d Caution: [C, ?] R/O bowel obst before use Contra: GI obst, allergy to PEG Disp: Powder for recons; bottle cap holds 17 g SE: Upset stomach, bloating, cramping, gas, severe D, hives NIPE: May take 2–4 d for BM; can add to H2O, juice, soda, coffee, or tea Polymyxin B & Hydrocortisone (Otobiotic Otic) [Antibi- otic/Anti-inflammatory] Uses: *Superficial bacterial Infxns of external ear canal* Action: Antibiotic/anti-inflammatory combo Dose: 4 gtt in ear(s) tid–qid Caution: [B, ?] Disp: Soln polymyxin B 10,000 units/hydrocortisone 0.5%/mL SE: Local irritation NIPE: Clean ear before instillation of gtts; N use w/ perforated eardrum; useful in neomycin allergy Posaconazole (Noxafil) [Anti-infective/Antifungal] Uses: *Prevent Aspergillus and Candida Infxns in severely immunocompromised*Ac- tion: ↓ Cell membrane ergosterol synth Dose: Adult. Invasive fungal prophylaxis: 200 mg PO tid; Oropharyngeal candidiasis: 100 mg PO daily × 13 d, if refractory 40 mg PO bid; Peds. >13 y: 200 mg PO tid; w/ meal Caution: [C; ?] Multiple drug interactions; ↑ QT, cardiac diseases, severe renal/liver impair Contra: Component hypersensitivity; w/ many drugs including alfuzosin, astemizole, alprazolam, phenothiazine, terfenadine, triazolam, others Disp: Sol 40 mg/mL SE: ↑ QT, ↑ LFTs, hepatic failure, fever, N/V/D, HA, abd pain, anemia, ↓ plt, ↓ K+ rash, dyspnea, cough, anorexia, fatigue Interactions: ↑ Effects OF CCB, cyclosporine, midazolam, sirolimus, statins, tacrolimus, vinca alkaloids; ↓ effects W/ cimetidine, phenytoin, rifabutin Labs:? ↑ LFTs; ↓ K+ , plts; monitor LFTs, electrolytes, CBC NIPE: Monitor for breakthrough fungal Infxns; N for children <13 y Potassium Citrate (Urocit-K) Uses: *Alkalinize urine, prevention of urinary stones (uric acid, Ca stones if hypocitraturia)* Action: Urinary alkalinizer Dose: 1 packet dissolved in H2O or 15–30 mL after meals and hs 10–20 mEq PO tid w/ meals, max 100 mEq/d Caution: [A, +] Contra: Severe renal impair, dehydration, ↑ K+, peptic ulcer; w/ K+-sparing diuretics, salt substitutes Disp: 540, 1080 mg tabs SE: GI upset, metabolic alkalosis Interactions: ↑ Risk of hyperkalemia W/ ACEIs, K+-sparing diuretics Labs: ↑ K+, ↓ Ca2+ NIPE: Take w/in 30 min of meals or hs snack; tabs 540 mg = 5 mEq, 1080 mg = 10 mEq Potassium Citrate & Citric Acid (Polycitra-K) [Urinary Alka- linizer] Uses: *Alkalinize urine, prevent urinary stones (uric acid, Ca stones if hypocitraturia)* Action: Urinary alkalinizer Dose: 10–20 mEq PO tid w/ meals, max 100 mEq/d Caution: [A, +] Contra: Severe renal impair, dehydration, ↑ K+, peptic ulcer; w/ use of K+-sparing diuretics or salt substitutes Disp: Soln 10 mEq/ 5 mL; powder 30 mEq/packet SE: GI upset, metabolic alkalosis Interactions: ↑ Risk OF hyperkalemia W/ ACEIs, K+-sparing diuretics Labs: ↑ K+ , ↑ Ca2+ Potassium Iodide [Lugol Soln] (SSKI, Thyro-Block) [Iodine Supplement] Uses: *Thyroid storm*, ↓ vascularity before thyroid surgery, 234 Potassium Supplements block thyroid uptake of radioactive iodine, thin bronchial secretions Action: Iodine supl Dose: Adults & Peds >2 y. Preop thyroidectomy: 50–250 mg PO tid (2–6 gtt strong iodine soln); give 10 d preop. Peds 1 y. Thyroid crisis: 300 mg (6 gtt SSKI q8h). Peds <1 y. 1/2 adult dose Caution: [D, +] ↑ K+, TB, PE, bronchitis, renal impair Contra: Iodine sensitivity Disp: Tabs 130 mg; soln (SSKI) 1 g/mL; Lugol soln, strong iodine 100 mg/mL; syrup 325 mg/5 mL SE: Fever, HA, urticaria, angioedema, goiter, GI upset, eosinophilia Interactions: ↑ Risk of hypothyroidism W/ antithyroid drugs and Li; ↑ risk of hyperkalemia W/ ACEIs, K+-sparing diuretics, K supls Labs: May alter TFTs NIPE: Take pc w/ food or milk Potassium Supplements (Kaon, Kaochlor, K-Lor, Slow-K, Micro-K, Klorvess, others) [K+ Supplement/Electrolyte] Uses: *Prevention or Rx of ↓ K+* (eg, diuretic use) Action: K+ supl Dose: Adults. 20–100 mEq/d PO ÷ daily–bid; IV 10–20 mEq/h, max 40 mEq/h & 150 mEq/d (monitor K+ levels frequently w/ high-dose IV). Peds. Calculate K+ deficit; 1–3 mEq/kg/d PO ÷ daily–qid; IV max dose 0.5–1 mEq/kg/h Caution: [A, +] Renal insuff, use w/ NSAIDs & ACE inhibitors Contra: ↑ K+ Disp: PO forms (Table 7); inj SE: GI irritation; bradycardia, ↑ K+, heart block Interactions: ↑ Effects W/ ACEI, K+-sparing diuretics, salt substitutes Labs: Follow K+; Cl- salt OK w/ alkalosis NIPE: Take w/ food; mix powder & Liq w/ beverage (unsalted tomato juice, etc); w/ acidosis use acetate, bicarbonate, citrate, or gluconate salt Pramipexole (Mirapex) [Antiparkinson Agent/Dopamine Agonist] Uses: *Parkinson Dz* Action: Dopamine agonist Dose: 1.5–4.5 mg/d PO, initial 0.375 mg/d in 3 ÷ doses; titrate slowly Caution: [C, ?/–] ↓ renal impair Contra: Component allergy Disp: Tabs 0.125, 0.25, 0.5, 1, 1.5 mg SE: Postural ↓ BP, asthenia, somnolence, abnormal dreams, GI upset, EPS Interactions: ↑ Ef- fects W/ cimetidine, diltiazem, quinidine, quinine, ranitidine, triamterene, verapamil; ↑ effects OF levodopa; ↑ CNS depression W/ CNS depressants, EtOH; ↓ effects W/ antipsychotics, butyrophenones, metoclopramide, phenothiazine, thioxanthenes NIPE: May take w/ food; N D/C abruptly Pramoxine (Anusol Ointment, ProctoFoam-NS, Others) [Topical Anesthetic] Uses: *Relief of pain & itching from hemorrhoids, anorectal surgery*; topical for burns & dermatosis Action: Topical anesthetic Dose: Apply freely to anal area q3h Caution: [C, ?] Disp: [OTC] All 1%; foam (Proctofoam-NS), cream, oint, lotion, gel, pads, spray SE: Contact dermatitis, mucosal thinning w/ chronic use NIPE: N Use on large areas Pramoxine + Hydrocortisone (Enzone, Proctofoam-HC) [Topical Anesthetic/Anti-inflammatory] Uses: *Relief of pain & itching from hemorrhoids* Action: Topical anesthetic, anti-inflammatory Dose: Apply freely to anal area tid–qid Caution: [C, ?/–] Disp: Cream pramoxine 1% acetate 0.5/1%; foam pramoxine 1% hydrocortisone 1%; lotion pramoxine 1% hydrocortisone 0.25/1/2.5%, pramoxine 2.5% & hydrocortisone 1% SE: Contact dermatitis, mucosal thinning w/ chronic use NIPE: N Use on large areas Pregabalin 235

Pravastatin (Pravachol) [Antilipemic/HMG-CoA Reductase Inhibitor] Uses: * ↓ Cholesterol* Action: HMG-CoA reductase inhibitor Dose: 10–80 mg PO hs; ↓ in significant renal/hepatic impair Caution: [X –] w/ gemfibrozil Contra: Liver Dz or persistent LFT ↑ Disp: Tabs 10, 20, 40, 80 mg SE: Use caution w/ concurrent gemfibrozil; HA, GI upset, hepatitis, myopathy, renal failure Interactions: ↑ Risk of myopathy & rhabdomyolysis W/ clarithromycin, clofibrate, cyclosporine, danazol, erythromycin, fluoxetine, gemfibrozil, niacin, nefazodone, troleandomycin; ↑ effects W/ azole antifungals, cimetidine, grapefruit juice; ↓ effects W/ cholestyramine, isradipine Labs: ↑ LFTs NIPE: N PRG, breast-feeding; take w/o regard to food; full effect may take up to 4 wk; ↑ risk of photosensitivity—use sunscreen Prazosin (Minipress) [Antihypertensive/Alpha Blocker] Uses: * HTN* Action: Peripherally acting α-adrenergic blocker Dose: Adults. 1 mg PO tid; can ↑ to 20 mg/d max PRN. Peds. 0.05–0.1 mg/kg/d in 3 div doses; max 0.5 mg. kg/d Caution: [C, ?] Contra: Component allergy, concurrent use of PDE-5 inhibitors Disp: Caps 1, 2, 5 mg; tabs XR 2.5, 5 mg XR SE: Dizziness, edema, palpitations, fatigue, GI upset Interactions: ↑ Hypotension W/ antihypertensives, diuretics, nitrates, EtOH; ↓ effects W/ NSAIDs, butcher’s broom Labs: ↑ Serum Na levels, vanillylmandelic acid level; alters test for pheochromocytoma NIPE: N D/C abruptly; can cause orthostatic ↓ BP, take the 1st dose hs; tolerance develops to this effect; tachyphylaxis may result Prednisolone [Corticosteroid] [See Steroids and Table 3] Interac- tions: ↑ Effects W/ clarithromycin, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin; ↓ effects W/ antacids, aminoglutethimide, barbiturates, cholestyramine, colestipol, phenytoin, rifampin; ↓ effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids Labs: False—skin allergy tests; false ↑ cortisol, digoxin, theophylline NIPE: N Use live-virus vaccines, N D/C abruptly; take w/ food Prednisone [Corticosteroid] [See Steroids and Table 3] Interactions: ↑ Effects W/ clarithromycin, cyclosporine, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin; ↓ effects W/ antacids, aminoglutethimide, barbiturates, carbamazepine, cholestyramine, colestipol, phenytoin, rifampin; ↓ effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids Labs: False skin allergy tests, false ↑ cortisol, digoxin, theophylline NIPE: Take w/ food; N use live-virus vaccine, N D/C abruptly, Infxn may be masked Pregabalin (Lyrica) [Antinociceptive/Antiseizure] Uses: *DM peripheral neuropathy pain; postherpetic neuralgia; fibromyalgia; adjunct w/ adult partial onset Sz* Action: Nerve transmission modulator, antinociceptive, antiseizure effect; mechanism; related to gabapentin Dose: Neuropathic pain: 50 mg PO tid, ↑ to 300 mg/d w/in 1 wk based on response, 300 mg/d max; Postherpetic neuralgia: 75–150 mg bid, or 50–100 mg tid; start 75 mg bid or 50 mg tid; ↑ to 300 mg/d w/in 1 wk PRN; if pain persists after 2–4 wk, ↑ to 600 mg/d; Epilepsy: 236 Probenecid

Start 150 mg/d (75 mg bid or 50 mg tid) may ↑ to max 600 mg/d; ↓ w/ renal insuff; w/ or w/o food Caution: [X, –] w/ significant renal impair (see insert), w/ elderly & severe CHF avoid abrupt D/C Contra: PRG Disp: Caps 25, 50, 75, 100, 150, 200, 225, 300 mg SE: Dizziness, drowsiness, xerostomia, edema, blurred vision, wt gain, difficulty concentrating NIPE: Avoid abrupt D/C; w/ D/C, taper over at least 1 wk Probenecid (Benemid, others) [Uricosuric/Analgesic] Uses: *Prevent gout & hyperuricemia; prolongs levels of PCNs & cephalosporins* Action: Uricosuric, renal tubular blocker of organic anions Dose: Adults. Gout: 250 mg bid × 1 wk, then 0.5 g PO bid; can ↑ by 500 mg/mo up to 2–3 g/d. Antibi- otic effect: 1–2 g PO 30 min before dose Peds >2 y. 25 mg/kg, then 40 mg/kg/d PO ÷ qid Caution: [B, ?] Contra: High-dose ASA, moderate–severe renal impair, age <2 y Disp: Tabs 500 mg SE: HA, GI upset, rash, pruritus, dizziness, blood dyscrasias Interactions: ↑ Effects OF acyclovir, allopurinol; ↑ effects OF benzodiazepines, cephalosporins, ciprofloxacin, clofibrate, dapsone, dyphylline, MTX, NSAIDs, olanzapine, rifampin, sulfonamides, sulfonylureas zidovudine; ↓ effects W/ niacin, EtOH; ↑ effects OF penicillamine Labs: False + urine glucose; false ↑ level of theophylline NIPE: Take w/ food, ↑ fluids to 2–3 L/d; N ASA, NSAIDs, salicylates; do not use during acute gout attack Procainamide (Pronestyl, Pronestyl SR, Procanbid) [Antiar- rhythmic] WARNING: Positive ANA titer or SLE w/ prolonged use; only use in life-treating arrhythmias; hematologic tox can be severe, follow CBC Uses: *Supraventricular/ventricular arrhythmias* Action: Class 1A antiarrhythmic (Table 10) Dose: Adults. Recurrent VF/VT: 20 mg/min IV (total 17 mg/kg max). Maint: 1–4 mg/min. Stable wide-complex tachycardia of unknown origin, AF w/ rapid rate in WPW: 20 mg/min IV until arrhythmia suppression, ↓ BP, or QRS widens >50%, then 1–4 mg/min. Chronic dosing: 50 mg/kg/d PO in ÷ doses q4–6h; Recurrent VF/VT: 20–50 mg/min IV; max total 17 mg/kg. Others: 20 mg/min IV until one these: arrhythmia stopped, hypotension, QRS widens >50%, total 17 mg/kg; then 1–4 mg/min (ECC 2005) Peds. Chronic maint: 15–50 mg/kg/24 h PO ÷ q3–6h; ↓ in renal/hepatic impair Caution: [C, +] Contra: Complete heart block, 2nd- or 3rd-degree heart block w/o pacemaker, torsades de pointes, SLE Disp: Tabs & caps 250, 500 mg; SR tabs 500, 750, 1000 mg; inj 100, 500 mg/mL SE: ↓ BP, lupus-like synd, GI upset, taste perversion, arrhythmias, tachycardia, heart block, angioneurotic edema, blood dyscrasias Notes: Levels: Trough: Just before next dose: Therapeutic: 4–10 μg/mL; NAPA+ procaine 5–30 μg/mL Toxic: >10 μg/mL; NAPA+ procaine >30 μg/mL; 1/2-life: procaine 3–5 h, NAPA 6–10 h Interactions: ↑ Effects W/ acetazolamide, amiodarone, cimetidine, ranitidine, trimethoprim; ↑ effects OF anticholinergics, antihypertensives; ↓ effects W/ procaine, EtOH Labs: ↑ LFTs NIPE: Take w/ food if GI upset; N crush SR tab Procarbazine (Matulane) [Antineoplastic/Alkylating Agent] WARNING: Highly toxic; handle w/ care Uses: *Hodgkin Dz*, NHL, brain & lung tumors Action: Alkylating agent; ↓ DNA & RNA synth Dose: Per protocol Propafenone 237

Caution: [D, ?] w/ EtOH ingestion Contra: Inadequate BM reserve Disp: Caps 50 mg SE: ↓ BM, hemolytic Rxns (w/ G6PD deficiency), N/V/D; disulfiram-like Rxn; cutaneous & constitutional Sxs, myalgia, arthralgia, CNS effects, azoosper- mia, cessation of menses Interactions: ↑ CNS depression W/ antihistamines, barbiturates, CNS depressants, narcotics, phenothiazine; ↑ risk of HTN W/ guanethidine, levodopa, MAOIs, methyldopa, sympathomimetics, TCAs, tyramine-containing foods; ↓ effects OF digoxin NIPE: Disulfiram-like Rxn w/ EtOH; ↑ fluids to 2–3 L/d; ↑ risk of photosensitivity—use sunscreen; N exposure to Infxn Prochlorperazine (Compazine) [Antiemetic, Antipsychotic/ Phenothiazine] Uses: *N/V, agitation, & psychotic disorders* Action: Phe- nothiazine; blocks postsynaptic dopaminergic CNS receptors Dose: Adults. Antiemetic: 5–10 mg PO tid–qid or 25 mg PR bid or 5–10 mg deep IM q4–6h. An- tipsychotic: 10–20 mg IM acutely or 5–10 mg PO tid–qid for maint; ↑ doses may be required for antipsychotic effect. Peds. 0.1–0.15 mg/kg/dose IM q4–6h or 0.4 mg/kg/24 h PO ÷ tid–qid Caution: [C, +/–] NAG, severe liver/cardiac Dz Contra: Phenothiazine sensitivity, BM suppression; age <2 y old or wt <9 kg Disp: Tabs 5, 10, 25 mg; SR caps 10, 15 mg; syrup 5 mg/5 mL; supp 2.5, 5, 25 mg; inj 5 mg/mL SE: EPS common; Rx w/ diphenhydramine or benztropine Interactions: ↑ Effects W/ chloroquine, indomethacin, narcotics, procarbazine, SSRIs, pyrimethamine; ↑ effects OF antidepressants, BBs, EtOH; ↓ effects W/ antacids, anticholinergics, barbiturates, tobacco; ↓ effects OF guanethidine, levodopa, Li Labs: False + urine bilirubin, amylase, phenylketonuria, ↑ serum prolactin NIPE: N D/C abruptly; ↑ risk of photosensitivity—use sunscreen; urine may turn pink/red Promethazine (Phenergan) [Antihistamine, Antiemetic, Sedative/Phenothiazine] Uses: *N/V, motion sickness* Action: Phe- nothiazine; blocks CNS postsynaptic mesolimbic dopaminergic receptors Dose: Adults. 12.5–50 mg PO, PR, or IM bid–qid PRN. Peds. 0.1–0.5 mg/kg/dose PO or IM q2–6h PRN Caution: [C, +/–] Use w/ agents w/ respiratory depressant effects Contra: Component allergy, NAG, age <2 y Disp: Tabs 12.5, 25, 50 mg; syrup 6.25 mg/5 mL, 25 mg/5 mL; supp 12.5, 25, 50 mg; inj 25, 50 mg/mL SE: Drowsi- ness, tardive dyskinesia, EPS, lowered Sz threshold, ↓ BP, GI upset, blood dyscrasias, photosens, respiratory depression in children Interactions: ↑ Effects W/ CNS depressants, MAOIs, EtOH; ↑ effects OF antihypertensives; ↓ effects W/ anticholinergics, barbiturates, tobacco; ↓ effect OF levodopa NIPE: Effects skin allergy tests; use sunscreen for photosensitivity Propafenone (Rythmol) [Antiarrhythmic] WARNING: Excess mortality or nonfatal cardiac arrest rate possible; avoid use in asymptomatic and symptomatic non-life-threatening ventricular arrhythmias Uses: *Life-threatening ventricular arrhythmias, AF* Action: Class IC antiarrhythmic (Table 10) Dose: Adults. 150–300 mg PO q8h. Peds. 8–10 mg/kg/d ÷ in 3–4 doses; may ↑ 2 mg/kg/d, 20 mg/kg/d max Caution: [C, ?] w/ amprenavir, ritonavir, MI w/in 2 y, w/liver/renal impair Contra: Uncontrolled CHF, bronchospasm, cardiogenic shock, AV block 238 Propantheline w/o pacer, Disp: Tabs 150, 225, 300 mg; XR caps 225, 325, 425 mg SE: Dizzi- ness, unusual taste, 1st-degree heart block, arrhythmias, prolongs QRS & QT intervals; fatigue, GI upset, blood dyscrasias Interactions: ↑ Effects W/ cimetidine, quinidine; ↑ effects OF anticoagulants, BBs, digitalis glycosides, theophylline; ↓ effects W/ rifampin, phenobarbital, rifabutin Labs: ↑ ANA titers NIPE: Take w/o regard to food Propantheline (Pro-Banthine) [Antimuscarinic] Uses: *PUD*, symptomatic Rx of small intestine hypermotility, spastic colon, ureteral spasm, bladder spasm, pylorospasm Action: Antimuscarinic Dose: Adults. 15 mg PO ac & 30 mg PO hs; ↓ in elderly. Peds. 2–3 mg/kg/24h PO ÷ tid–qid Caution: [C, ?] Contra: NAG, ulcerative colitis, toxic megacolon, GI/GU obst Disp: Tabs 7.5, 15 mg SE: Anticholinergic (eg, xerostomia, blurred vision) Interactions: ↑ Anti- cholinergic effects W/ antihistamines, antidepressants, atropine, haloperidol, phenothiazines, quinidine, TCAs; ↑ effects OF atenolol, digoxin; ↓ effects W/ antacids NIPE: May cause heat intolerance, ↑ risk of photosensitivity—use sunscreen Propofol (Diprivan) [Anesthetic] Uses: *Induction & maint of anesthesia; sedation in intubated pts* Action: Sedative–hypnotic; mechanism unknown; acts in 40 sec Dose: Adults. Anesthesia: 2–2.5 mg/kg (also ECC 2005), then 0.1–0.2 mg/kg/ min inf; ICU sedation: 5 μg/kg/min IV × 5 min, ↑ PRN 5–10 μg/kg/min q5–10 min 5–50 μg/kg/min cont inf; Peds. Anesthesia: 2.5–3.5 mg/kg induction; then 125–300 μg/kg/min; ↓ in elderly, debilitated, ASA II/IV pts Cau- tion: [B, +] Contra: If general anesthesia contraindicated, sensitivity to egg, egg products, soybeans, soybean products Disp: Inj 10 mg/mL SE: ↓ BP, pain at site, apnea, anaphylaxis Notes: 1 mL has 0.1 g fat Interactions: ↑ Effects W/ antihistamines, opioids, hypnotics, EtOH Labs: ↓ Serum cortisol levels; may ↑ triglycerides w/ extended dosing Propoxyphene (Darvon); Propoxyphene & Acetaminophen (Darvocet); & Propoxyphene & Aspirin (Darvon Com- pound-65, Darvon-N + Aspirin) [C-IV] [Narcotic Analgesic] WARNING: Excessive doses alone or in combo w/ other CNS depressants can be cause of death; use w/ caution in depressed or suicidal patients Uses: *Mild– moderate pain* Action: Narcotic analgesic Dose: 1–2 PO q4h PRN; ↓ in hepatic impair, elderly Caution: [C (D if prolonged use), M] Hepatic impair (APAP), peptic ulcer (ASA); severe renal impair, h/o EtOH abuse Contra: Allergy, suicide risk, h/o drug abuse Disp: Darvon: Propoxyphene HCl caps 65 mg. Darvon-N: Propoxyphene napsylate 100-mg tabs. Darvocet-N: Propoxyphene napsylate 50 mg/ APAP 325 mg. Darvocet-N 100: Propoxyphene napsylate 100 mg/APAP 650 mg. Darvon Compound-65: Propoxyphene HCl caps 65-mg/ASA 389 mg/caffeine 32 mg. Darvon-N w/ ASA: Propoxyphene napsylate 100 mg/ASA 325 mg SE: OD can be lethal; ↓ BP, dizziness, sedation, GI upset Interactions: ↑ CNS depression W/ antidepressants, antihistamines, barbiturates, glutethimide, methocarbamol, protease inhibitors, EtOH, St. John’s wort; ↑ effects OF BBs, carbamazepine, Protamine 239

MAOIs, phenobarbital, TCAs, warfarin; ↓ effects W/ tobacco Labs: ↑ LFTs, serum amylase, lipase NIPE: Take w/ food if GI upset Propranolol (Inderal) [Antihypertensive, Antianginal, An- tiarrhythmic/BB] Uses: *HTN, angina, MI, hyperthyroidism, essential tremor, hypertrophic subaortic stenosis, pheochromocytoma; prevents migraines & β β β β atrial arrhythmias* Action: -Adrenergic receptor blocker, 1, 2; only -blocker to block conversion of T4 to T3 Dose: Adults. Angina: 80–320 mg/d PO ÷ bid–qid or 80–160 mg/d SR. Arrhythmia: 10–80 mg PO tid–qid or 1 mg IV slowly, repeat q5 min, 5 mg max. HTN: 40 mg PO bid or 60–80 mg/d SR, ↑ weekly to max 640 mg/d. Hypertrophic subaortic stenosis: 20–40 mg PO tid–qid. MI: 180–240 mg PO ÷ tid–qid. Migraine prophylaxis: 80 mg/d ÷ qid–tid, ↑ weekly 160–240 mg/d ÷ tid–qid max; wean if no response in 6 wk. Pheochromocytoma: 30–60 mg/d ÷ tid–qid. Thyro- toxicosis: 1–3 mg IV × 1; 10–40 mg PO q6h. Tremor: 40 mg PO bid, ↑ PRN 320 mg/d max; 0.1 mg/kg slow IV push, divided 3 equal doses q2–3min, max 1 mg/min; repeat in 2 min PRN (ECC 2005) Peds. Arrhythmia: 0.5–1.0 mg/kg/d ÷ tid–qid, ↑ PRN q3–7d to 60 mg/d max; 0.01–0.1 mg/kg IV over 10 min, 1 mg max. HTN: 0.5–1.0 mg/kg ÷ bid–qid, ↑ PRN q3–7d to 2 mg/kg/d max; ↓ in renal impair Caution: [C (1st tri, D if 2nd or 3rd tri), +] Contra: Uncompensated CHF, cardiogenic shock, bradycardia, heart block, PE, severe resp Dz Disp: Tabs 10, 20, 40, 80 mg; SR caps 60, 80, 120, 160 mg; oral soln 4, 8, mg/mL; inj 1 mg/mL SE: Bradycardia, ↓ BP, fatigue, GI upset, ED Interactions: ↑ Effects W/ antihypertensives, cimetidine, hydralazine, neuroleptics, nitrates, propylthiouracil, theophylline, EtOH; ↑ effects OF digitalis, glycosides, hypoglycemics, hydralazine, lidocaine, neuroleptics; ↓ effects W/ NSAIDs, phenobarbital, phenytoin, rifampin, tobacco Labs: ↑ LFTs, BUN; ↑ or ↓ serum glucose; ↓ plts, thyroxine; NIPE: N D/C abruptly; ↑ cold sensitivity Propylthiouracil [PTU] [Antithyroid Agent/Thyroid Hor- ↓ mone Antagonist] Uses: *Hyperthyroidism* Action: Production of T3 & T4 & conversion of T4 to T3 Dose: Adults. Initial: 100 mg PO q8h (may need up to 1200 mg/d); after pt euthyroid (6–8 wk), taper dose by 1/2 q4–6wk to maint, 50–150 mg/24 h; can usually D/C in 2–3 y; ↓ in elderly Peds. Initial: 5–7 mg/kg/24 h PO ÷ q8h. Maint: 1/3–2/3 of initial dose Caution: [D, –] Contra: Allergy Disp: Tabs 50 mg SE: Fever, rash, leukopenia, dizziness, GI upset, taste perversion, SLE-like synd Interactions: ↑ Effects W/ iodinated glycerol, Li, KI, NaI Labs: ↑ LFTs, PT; ↑ effects of anticoagulants; monitor TFT NIPE: Take w/ food for GI upset; omit dietary sources of I; full effects take 6–12 wk; monitor pt clinically; Protamine (Generic) [Heparin Antagonist] Uses: *Reverse heparin effect* Action: Neutralize heparin by forming a stable complex Dose: Based on degree of heparin reversal; give IV slowly; 1 mg reverses approx 100 units of heparin given in the preceding 3–4 h, 50 mg max Caution: [C, ?] Contra: Allergy Disp: Inj 10 mg/mL SE: Follow coags; anticoag effect if given w/o heparin; ↓ BP, bradycardia, dyspnea, hemorrhage Interactions: Incompatible W/ many penicillins & cephalosporins—N mix 240 Pseudoephedrine

Pseudoephedrine (Sudafed, Novafed, Afrinol, Others) [OTC] [Decongestant/Sympathomimetic] Uses: *Decongestant* Action: Stimulates α-adrenergic receptors w/ vasoconstriction Dose: Adults. 30–60 mg PO q6–8h Peds. 4 mg/kg/24 h PO ÷ qid; ↓ in renal insuff Caution: [C, +] Contra: Poorly controlled HTN or CAD, w/ MAOIs Disp: Tabs 30, 60 mg; caps 60 mg; SR tabs 120, 240 mg; Liq 7.5 mg/0.8 mL, 15, 30 mg/5 mL SE: HTN, insomnia, tachycardia, arrhythmias, nervousness, tremor Interactions: ↑ Risk of HTN crisis W/ MAOIs; ↑ effects W/ BBs, sympathomimetics; ↓ effects W/ TCAs; ↓ effect OF methyldopa, reserpine NIPE: Found in many OTC cough/cold preparations; OTC restricted distribution Psyllium (Metamucil, Serutan, Effer-Syllium) [Laxative] Uses: *Constipation & colonic diverticular Dz * Action: Bulk laxative Dose: 1 tsp (7 g) in glass of H2O PO daily–tid Caution: [B, ?] Effer-Syllium (effervescent psyllium) usually contains K+ caution w/ renal failure; phenylketonuria (in products w/ aspartame) Contra: Suspected bowel obst Disp: Granules 4, 25 g/tsp; powder 3.5 g/packet, caps 0.52g (3 g/6 caps), wafers 3.4 g/dose SE: D, abd cramps, bowel obst, constipation, bronchospasm Interactions: ↓ Effects OF digitalis glycosides, K-sparing diuretics, nitrofurantoin, salicylates, tetracyclines, warfarin NIPE: Psyl- lium dust inhalation may cause wheezing, runny nose, watery eyes Pyrazinamide (Generic) [Antitubercular] Uses: *Active TB in combo w/ other agents* Action: Bacteriostatic; unknown mechanism Dose: Adults. 15–30 mg/kg/24 h PO ÷ tid–qid; max 2 g/d; dosing based on lean body wt; ↓ dose in renal/hepatic impairment Peds. 15–30 mg/kg/d PO ÷ daily–bid; ↓ w/ renal/hepatic impair Caution: [C, +/–] Contra: Severe hepatic damage, acute gout Disp: Tabs 500 mg SE: Hepatotox, malaise, GI upset, arthralgia, myalgia, gout, photosens Interactions: ↓ Effects OF probenecid Labs: ↑ Uric acid NIPE: ↑ Risk of photosensitivity—use sunscreen; ↑ fluids to 2 L/d; Use in combo w/ other anti-TB drugs; consult MMWR for latest TB recommendations; dosage regimen differs for “directly observed” therapy Pyridoxine [Vitamin B6] [Vitamin B6 Supplement] Uses: *Rx & prevention of vitamin B6 deficiency* Action: Vitamin B6 supl Dose: Adults. De- ficiency: 10–20 mg/d PO. Drug-induced neuritis: 100–200 mg/d; 25–100 mg/d prophylaxis. Peds. 5–25 mg/d × 3 wk Caution: [A (C if doses exceed RDA), +] Contra: Component allergy Disp: Tabs 25, 50, 100 mg; inj 100 mg/mL SE: Aller- gic Rxns, HA, N Interactions: ↓ Effects OF levodopa, phenobarbital, phenytoin Labs: ↑ AST; ↓ folic acid NIPE: Antidote for isoniazid poisoning Quadrivalent Human Papillomavirus (HPV Types 6, 11, 16, 18) Recombinant Vaccine (Gardasil) [Vaccine] Uses: Prevent cervical CA, genital warts, cervical adenocarcinoma in situ, cervical intraepithelial neoplasia grades 2 & 3, vulvar intraepithelial neoplasia grades 2 & 3, vaginal intraepithelial neoplasia grades 2 & 3, cervical intraepithelial neoplasia grade 1 caused by HPV types 6, 11, 16, 18 Dose: 0.5 mL IM inj in deltoid or upper thigh Peds. <9 y: Quinidine 241

Not recommended; Females. 9–26 y: Give 1st, 2nd dose 2 mo >1st, 3rd dose 6 mo >1st dose Caution: [B, –]; Disp: 0.5 mL for IM inj SE: Inj site reaction, fever In- teractions: ↓ Response W/ immunosuppressants NIPE: May not protect all recipients; not a substitute for routine cervical screening Quazepam (Doral) [C-IV] [Sedative/Hypnotic/Benzodi- azempine] Uses: *Insomnia* Action: Benzodiazepine Dose: 7.5–15 mg PO hs PRN; ↓ in elderly & hepatic failure Caution: [X, ?/–] NA glaucoma Contra: PRG, sleep apnea Disp: Tabs 7.5, 15 mg SE: Sedation, hangover, somnolence, resp depression Interactions: ↑ Effects W/ azole antifungals, cimetidine, digoxin, disulfiram, INH, levodopa, macrolides, neuroleptics, phenytoin, quinolones, SSRIs, verapamil, grapefruit juice, EtOH; ↓ effects W/ carbamazepine, rifampin, rifabutin, tobacco NIPE: N Breastfeed, PRG; N D/C abruptly; use barrier contraception Quetiapine (Seroquel, Seroquil XR) [Antipsychotic] WARN- ING: Closely monitor pts for worsening depression or emergence of suicidality, particularly in ped pts; ↑ mortality in elderly with dementia-related psychosis Uses: *Acute exacerbations of schizophrenia* Action: Serotonin & dopamine antagonism Dose: 150–750 mg/d; initiate at 25–100 mg bid–tid; slowly ↑ dose; XR: 400–800 mg PO qPM, start 300 mg/d, ↑ 300 mg/d, 800 mg/d max ↓ dose w/ hepatic & geriatric pts Caution: [C, –] Contra: Component allergy Disp: Tabs 25, 50, 100, 200, 300, 400 mg; 200, 300, 400 XR SE: Confusion w/ nefazodone; HA, somnolence, ↑ wt, ↓ BP, dizziness, cataracts, neuroleptic malignant synd, tardive dyskinesia, ↑ QT internal Interactions: ↑ Effects W/ azole antifungals, cimetidine, macrolides, EtOH; ↑ effects OF antihypertensives, lorazepam; ↓ effects W/ barbiturates, carbamazepine, glucocorticoids, phenytoin, rifampin, thioridazine; ↓ effects OF dopamine antagonists, levodopa Labs: ↑ LFTs, cholesterol, triglycerides NIPE: ↑ risk OF cataract formation, tardive dyskinesia; take w/o regard to food; ↓ body temp regulation Quinapril (Accupril) [Antihypertensive/ACEI] WARNING: ACE inhibitors used during PRG can cause fetal injury & death Uses: *HTN, CHF, DN, post-MI* Action: ACE inhibitor Dose: 10–80 mg PO daily; ↓ in renal impair Cau- tion: [D, +] w/ RAS, volume depletion Contra: ACE inhibitor sensitivity, angioedema, PRG Disp: Tabs 5, 10, 20, 40 mg SE: Dizziness, HA, ↓ BP, impaired renal Fxn, angioedema, taste perversion, cough Interactions: ↑ Effects W/ diuretics, antihypertensives; ↑ effects OF insulin, Li; ↓ effects W/ ASA, NSAIDs; ↓ effects OF quinolones, tetracyclines Labs: ↑ K+, ↓ LFTs NIPE: ↓ Absorption W/ high-fat foods; ↑ risk of cough Quinidine (Quinidex, Quinaglute) [Antiarrhythmic/Antimalarial] Uses: *Prevention of tachydysrhythmias, malaria* Action: Class 1A antiarrhythmic Dose: Adults. AF/flutter conversion: After digitalization, 200 mg q2–3h × 8 doses; ↑ daily to 3–4 g max or nl rhythm. Peds. 15–60 mg/kg/24 h PO in 4–5 ÷ doses; ↓ in renal impair Caution: [C, +] w/ ritonavir Contra: Digitalis tox & AV block; conduction disorders Disp: Sulfate: Tabs 200, 300 mg; SR tabs 300 mg. 242 Quinupristin–Dalfopristin

Gluconate: SR tabs 324 mg; inj 80 mg/mL SE: Extreme ↓ BP w/ IV use; syncope, QT prolongation, GI upset, arrhythmias, fatigue, cinchonism (tinnitus, hearing loss, delirium, visual changes), fever, hemolytic anemia, thrombocytopenia, rash Notes: Levels: Trough: Just before next dose; Therapeutic: 2–5 μg/mL; Toxic: >10 μg/mL; 1/2 life: 6–8h; sulfate salt 83% quinidine; gluconate salt 62% quinidine Interactions: ↑ Effects W/ acetazolamide, antacids, amiodarone, azole antifungals, cimetidine, K, macrolides, NaHCO3, thiazide diuretics, lily-of-the-valley, pheasant’s eye herb, scopolia root, squill; ↑ effects OF anticoagulants, dextromethorphan, digitalis glycosides, disopyramide, haloperidol, metoprolol, nifedipine, procainamide, propafenone, propranolol, TCAs, verapamil; ↓ effects W/ barbiturates, disopyramide, nifedipine, phenobarbital, phenytoin, rifampin, sucralfate NIPE: Take w/ food, ↑ risk of photosensitivity—use sunscreen; use w/ drug that slows AV conduction (eg, digoxin, diltiazem, β-blocker) Quinupristin–Dalfopristin (Synercid) [Antibiotic/Streptogramin] Uses: *Vancomycin-resistant Infxns due to E. faecium & other gram(+)* Action: ↓ Ribosomal protein synth. Spectrum: Vanco-resistant E. faecium, methicillin-susceptible S. aureus, S. pyogenes; not against E. faecalis Dose: Adults & Peds. 7.5 mg/kg IV q8–12h (central line preferred); incompatible w/ NS or heparin; flush IV w/ dextrose; ↓ w/ hepatic failure Caution: [B, M] Multiple drug interactions (eg, cyclosporine) Contra: Component allergy Disp: Inj 500 mg (150 mg quinupristin/350 mg dalfopristin) 600 mg (180 quinupristin/420 mg dalfopristin) SE: Hyperbilirubinemia, arthralgia, myalgia Interactions: ↑ Effects OF CCBs, carbamazepine, cyclosporine, diazepam, disopyramide, docetaxel, lovastatin, methylprednisolone, midazolam, paclitaxel, protease inhibitors, quinidine, tacrolimus, vinblastine Labs: ↑ ALT, AST, bilirubin; NIPE: Inf site Rxns & pain Rabeprazole (AcipHex) [Antiulcer Agent/Proton Pump In- hibitor] Uses: *PUD, GERD, ZE* H. pylori Action: Proton-pump inhibitor Dose: 20 mg/d; may ↑ to 60 mg/d; H. pylori 20 mg PO bid × 7 d (w/ amoxicillin and clarithromycin); do not crush/chew tabs Caution: [B, ?/–] Disp: Tabs 20 mg ER SE: HA, fatigue, GI upset Interactions: ↑ Effects OF cyclosporine, digoxin; ↓ effects OF ketoconazole Labs: ↑ LFTs, TSH NIPE: Take w/o regard to food; ↑ risk of photosensitivity—use sunscreen Raloxifene (Evista) [Selective Estrogen Receptor Modulator] Uses: *Prevent osteoporosis* Action: Partial antagonist of estrogen, behaves like estrogen Dose: 60 mg/d Caution: [X, –] Contra: Thromboembolism, PRG Disp: Tabs 60 mg SE: Chest pain, insomnia, rash, hot flashes, GI upset, hepatic dysfunction Interactions: ↓ Effects W/ ampicillin, cholestyramine NIPE: N PRG, breast- feeding; take w/o regard to food; ↑ risk of venous thromboembolic effects Ramelteon (Rozerem) [Hypnotic] Uses: Short-term RX of insomnia esp w/ difficulty of sleep onset Action: Hypnotic agent Dose: 8 mg tabs PO w/in 30 min of bedtime Caution: [C, –] Contra: Severe hepatic impair; concurrent use of fluvoxamine Disp: 8 mg tabs SE: HA, N, somnolence, fatigue, dizziness, URI, Rasagiline Mesylate 243 depression, D, myalgia, arthralgia Interactions: ↑ Effects W/ CYP1A2 inhibitors (fluvoxamine), CYP3A4 inhibitors (ketoconazole), and CYP2C9 inhibitors (fluconazole); ↓ effects W/ CYP450 inducers (rifampin) Labs: ↓ Testosterone levels & ↑ prolactin levels noted NIPE: High-fat foods delay effect; N use in pts W/ severe sleep apnea & severe COPD Ramipril (Altace) [Antihypertensive/ACEI] WARNING: ACE inhibitors used during PRG can cause fetal injury & death Uses: *HTN, CHF, DN, post-MI* Action: ACE inhibitor Dose: 2.5–20 mg/d PO ÷ daily–bid; ↓ in renal failure Caution: [D, +] Contra: ACE-inhibitor-induced angioedema Disp: Caps 1.25, 2.5, 5, 10 mg SE: Cough, HA, dizziness, ↓ BP, renal impair, angioedema In- teractions: ↑ Effects W/ α-adrenergic blockers, loop diuretics; ↑ effects OF insulin, Li; ↑ risk of hyperkalemia W/ K+, K-sparing diuretics, K salt substitutes, trimethoprim, ↓ effects W/ ASA, NSAIDs, food Labs: ↑ BUN, Cr, K+, ↓ HMG, Hct, cholesterol NIPE: ↑ Risk of photosensitivity—use sunscreen; ↑ risk of cough esp w/ capsaicin; take w/o food; OK in combo w/ diuretics Ranibizumab (Lucentis) [Vascular Endothelial GF Inhibitor] Uses: *Neovascular “wet” macular degeneration* Action: Vascular endothelial growth factor inhibitor Dose: 0.5 mg intravitreal inj qmo Caution: [C; ?] h/o thromboembolism Contra: periocular Infxn Disp: Inj SE: Endophthalmitis, retinal detachment/hemorrhage, cataract, intraocular inflammation, conjunctival hemorrhage, eye pain, floaters Ranitidine Hydrochloride (Zantac) [Antiulcer Agent/H2- Receptor Antagonist] Uses: *Duodenal ulcer, active benign ulcers, hypersecretory conditions, & GERD* Action: H2-receptor antagonist Dose: Adults. Ulcer: 150 mg PO bid, 300 mg PO hs, or 50 mg IV q6–8h; or 400 mg IV/d cont inf, then maint of 150 mg PO hs. Hypersecretion: 150 mg PO bid, up to 600 mg/d. GERD: 300 mg PO bid; maint 300 mg PO hs. Dyspepsia: 75 mg PO daily–bid Peds. 0.75–1.5 mg/kg/dose IV q6–8h or 1.25–2.5 mg/kg/dose PO q12h; ↓ in renal insuff/failure Caution: [B, +] Contra: Component allergy Disp: Tabs 75 [OTC], 150, 300 mg; Caps 150, 300 mg; effervescent tabs 150 mg; syrup 15 mg/mL; inj 25 mg/mL SE: Dizziness, sedation, rash, GI upset Interactions: ↑ Effects OF glipizide, glyburide, procainamide, warfarin; ↓ effects W/ antacids, tobacco; ↓ effects OF diazepam Labs: ↑ SCr, ALT NIPE: ASA, NSAIDs, EtOH, caffeine ↑ stomach acid production; PO & parenteral doses differ Ranolazine (Ranexa) [Antianginal] Uses: *Chronic angina*Ac- tion: ↓ ischemia-related Na+ entry into myocardium Dose: Adults. 500 mg PO bid to 1000 mg PO bid Contra: w/ hepatic impair, CYP3A inhibitors (Table 11); w/ agents that ↑ QT interval Caution: [C, ?/–] HTN may develop w/ renal impairment Disp: SR tabs 500 mg SE: Dizziness, HA, constipation, arrhythmias Labs: ↓ K+ NIPE: Not 1st line; use w/ amlodipine, nitrates, β-blockers Rasagiline Mesylate (Azilect) [Anti-Parkinson Agent/MAO B Inhibitor] Uses: *Early Parkinson disease monotherapy; levodopa adjunct 244 Rasburicase w/ advanced Dz* Action: MAO B inhibitor Dose: Adults. Early Dz: 1 mg PO daily, start 0.5 mg PO daily w/ levodopa; ↓ w/ CYP1A2 inhibitors or hepatic impair Contra: MAOIs, sympathomimetic amines, meperidine, methadone, tramadol, propoxyphene, dextromethorphan, mirtazapine, cyclobenzaprine, St. John’s wort, sympathomimetic vasoconstrictors, general anesthetics, SSRIs Caution: [C, ?] Avoid tyramine-containing foods; moderate/severe hepatic impairment Disp: Tabs 0.5, 1 mg SE: Arthralgia, indigestion, dyskinesia, hallucinations, ↓ wt, postural ↓ BP, N, V, constipation, xerostomia, rash, sedation, CV conduction disturbances Interactions:↑ Risk of HTN crisis W/ tyramine-containing foods; ↑ effects W/ ciprofloxacin; ↑ CNS tox/death W/ TCA, SSRIs, MAOIs Labs: Monitor LFTs NIPE: Rare melanoma reported; do periodic dermatologic exams; D/C 14 d prior to elective surgery; D/C fluoxetine 5 wk before starting rasagiline; initial ↓ levodopa dose recommended Rasburicase (Elitek) [Antigout Agent/Antimetabolite] Uses: *Reduce ↑ uric acid due to tumor lysis (peds)* Action: Catalyzes uric acid Dose: Peds. 0.15 or 0.20 mg/kg IV over 30 min, daily × 5 Caution: [C, ?/–] Falsely ↓ uric acid values Contra: Anaphylaxis, screen for G6PD deficiency to avoid hemolysis, methemoglobinemia Disp: 1.5 mg inj SE: Fever, neutropenia, GI upset, HA, rash Labs: ↓ Neutrophils NIPE: Place blood test tube for uric acid level on ice to stop enzymatic Rxn; removed by dialysis Repaglinide (Prandin) [Hypoglycemic/Meglitinide] Uses: *Type 2 DM* Action: ↑ pancreatic insulin release Dose: 0.5–4 mg ac, PO start 1–2 mg, ↑ to 16 mg/d max; take pc Caution: [C, ?/–] Contra: DKA, type 1 DM Disp: Tabs 0.5, 1, 2 mg SE: HA, hyper-/hypoglycemia, GI upset Interactions: ↑ Effects W/ ASA, BBs, chloramphenicol, erythromycin, ketoconazole, miconazole, MAOIs, NSAIDs, probenecid, sulfa drugs, warfarin, celery, coriander, dandelion root, fenugreek, garlic, ginseng, juniper berries; ↓ effects W/ barbiturates, carbamazepine, CCBs, corticosteroids, diuretics, estrogens, INH, OCPs, phenytoin, phenothiazines, rifampin, sympathomimetics, thiazide diuretics, thyroid drugs NIPE: Take 15 min before meal; skip drug if meal skipped Retapamulin (Altabax) [Pleuromutilin Antibiotic] Uses: *Topi- cal Rx impetigo in patients >9 mo* Action: Pleuromutilin antibiotic; Spectrum: S. aureus (MRSA), S. pyogenes Dose: Apply bid × 5 d Caution: [B; ?] Disp: 10 mg/1 g SE: Local irritation NIPE: Prolonged use may result in super Infxn Reteplase (Retavase) [Tissue Plasminogen Activator] Uses: *Post-AMI* Action: Thrombolytic Dose: 10 units IV over 2 min, 2nd dose in 30 min, 10 units IV over 2 min; 10 units IV bolus over 2 min; 30 min later, 10 units IV bolus over 2 min NS flush before and after each dose (ECC 2005) Caution: [C, ?/–] Contra: Internal bleeding, spinal surgery/trauma, h/o CNS AVM, uncontrolled ↓ BP, sensitivity to thrombolytics Disp: Inj 10.8 units/2 mL SE: Bleed- ing, allergic Rxns Interactions: ↑ Risk of bleeding W/ ASA, abciximab, dipyridamole, heparin, NSAIDs, oral anticoagulants, vitamin K antagonists Labs: Rifampin 245

↓ Fibrinogen, plasminogen NIPE: Monitor ECG during Rx for ↑ risk of reperfu- sion arrhythmias Ribavirin (Virazole, Copegus) [Antiviral/Nucleoside Ana- logue] WARNING: Monotherapy for chronic Hep C ineffective; hemolytic anemia possible, teratogenic and embryocidal Uses: *RSV Infxn in infants [Vira- zole]; Hep C (in combo w/ interferon alfa-2b [Copegus])* Action: Unknown Dose: RSV: 6 g in 300 mL sterile H2O, inhale over 12–18 h. Hep C: 600 mg PO bid in combo w/ interferon alfa-2b (see Rebetron) Caution: [X, ?] May accumulate on soft contact lenses Contra: PRG, autoimmune hepatitis, CrCl <50 mL/min Disp: Powder for aerosol 6 g; tabs 200, 400, 600 mg, caps 200 mg, soln 40 mg/mL, SE: Fatigue, HA, GI upset, anemia, myalgia, alopecia, bronchospasm Interactions: ↓ Effects W/ Al, Mg, simethicone; ↓ effect OF zidovudine Labs: ↑ LFTs; ↓ HMG, Hct, plts, WBC; monitor labs NIPE: N PRG, breast-feeding; PRG test monthly; ↑ risk of photosensitivity—use sunscreen; take w/o regard to food; Virazole aerosolized by a SPAG Rifabutin (Mycobutin) [Antibiotic/Antitubercular] Uses: *Prevent M. avium complex Infxn in AIDS pts w/ CD4 count <100* Action: ↓ DNA-dependent RNA polymerase activity Dose: Adults. 150–300 mg/d PO. Peds. 1 y: 15–25 mg/kg/d PO. 2–10 y: 4.4–18.8 mg/kg/d PO. 14–16 y: 2.8–5.4 mg/kg/d PO Caution: [B; ?/–] WBC <1000/mm3 or plts <50,000/mm3; ritonavir Contra: Allergy Disp: Caps 150 mg SE: Discolored urine, rash, neutropenia, leukopenia, myalgia Interactions: ↑ Effects W/ ritonavir; ↓ effects OF anticoagulants, anticonvulsants, barbiturates, benzodiazepines, BBs, corticosteroids, methadone, morphine, OCPs, quinidine, theophylline, TCAs Labs: ↑ LFTs NIPE: Urine and body fluids may turn reddish brown in color, discoloration of soft contact lenses, use barrier contraception, take w/o food; SE/interactions similar to Rifampin Rifampin (Rifadin) [Antibiotic/Antitubercular] Uses: *TB & Rx & prophylaxis of N. meningitidis, H. influenzae, or S. aureus carriers*; adjunct w/ severe S. aureus Action: ↓ DNA-dependent RNA polymerase Dose: Adults. N. meningitidis & H. influenzae carrier: 600 mg/d PO for 4 d; TB: 600 mg PO or IV daily or 2 ×/wk w/ combo regimen. Peds. 10–20 mg/kg/dose PO or IV daily–bid; ↓ in hepatic failure Caution: [C, +] Amprenavir, multiple drug interactions Contra: Allergy, active N. meningitidis Infxn, w/ saquinavir/ritonavir Disp: Caps 150, 300 mg; inj 600 mg SE: Red-orange colored bodily fluids, ↑ LFTs, flushing, HA In- teractions: ↓ Effects W/ aminosalicylic acid; ↓ effects OF acetaminophen, aminophylline, amiodarone, anticoagulants, barbiturates, BBs, CCBs, chloramphenicol, clofibrate, delavirdine, digoxin, disopyramide, doxycycline, enalapril, estrogens, haloperidol, hypoglycemics, hydantoins, methadone, morphine, nifedipine, ondansetron, OCPs, phenytoin, protease inhibitors, quinidine, repaglinide, sertraline, sulfapyridine, sulfones, tacrolimus, theophylline, thyroid drugs, tocainide, TCAs, theophylline, verapamil, zidovudine, zolpidem Labs: ↑ LFTs, uric acid NIPE: Use 246 Rifapentine barrier contraception; take w/o food, reddish brown color in urine and body fluids; stains soft contact lenses; Never use as single agent w/ active TB Rifapentine (Priftin) [Antibiotic/Antitubercular] Uses: *Pulm TB* Action: ↓ DNA-dependent RNA polymerase. Spectrum: M. tuberculosis Dose: Intensive phase: 600 mg PO 2 ×/wk for 2 mo; separate doses by >3 d. Con- tinuation phase: 600 mg/wk for 4 mo; part of 3–4 drug regimen Caution: [C, red- orange breast milk] ↓ protease inhibitor efficacy, antiepileptics, β-blockers, CCBs Contra: Rifamycins allergy Disp: 150-mg tabs SE: Neutropenia, hyperuricemia, HTN, HA, dizziness, rash, GI upset, blood dyscrasias, ↑ LFTs, hematuria, discolored secretions Interactions: ↓ Effects OF anticoagulants, BBs, CCBs, corticosteroids, cyclosporine, digoxin, fluoroquinolones, methadone, metoprolol, OCPs, phenytoin, propranolol, protease inhibitors, rifampin, sulfonylureas, TCAs, theophylline, verapamil, warfarin Labs: ↑ LFTs-monitor; plts, uric acid; ↓ HMG, neutrophil, WBCs NIPE: May take with food; body fluids, teeth, tongue, feces may become orange-red; may permanently discolor soft contact lenses; use barrier contraception Rifaximin (Xifaxan) [Antibiotic/Rifamycin Antibacterial] Uses: *Travelers’ diarrhea (noninvasive strains of E. coli) in patients >12 y* Action: Not absorbed, derivative of rifamycin. Spectrum: E. coli Dose: 1 tab PO daily × 3 d Caution: [C, ?/–] h/o allergy; pseudomembranous colitis Contra: Al- lergy to rifamycins Disp: Tabs 200 mg SE: Flatulence, HA, abd pain, GI distress, fever Interactions: None significant Labs: None noted NIPE: May be taken w/o regard to food; N crush/chew tabs-swallow whole; D/C if Sxs worsen or persist >24–48 h, or w/ fever or blood in stool Rimantadine (Flumadine) [Antiviral] Uses: *Prophylaxis & Rx of influenza A viral Infxns* Action: Antiviral Dose: Adults & Peds >9 y. 100 mg PO bid. Peds 1–9 y. 5 mg/kg/d PO, 150 mg/d max; daily w/ severe renal/hepatic impair & elderly; initiate w/in 48 h of Sx onset Caution: [C, –] w/ cimetidine; avoid w/ PRG, breast-feeding Contra: Component & amantadine allergy Disp: Tabs 100 mg; syrup 50 mg/5 mL SE: Orthostatic ↓ BP, edema, dizziness, GI upset, ↓ Sz threshold Interactions: ↑ Effects W/ cimetidine; ↓ effects W/ acetaminophen, ASA NIPE: See CDC (MMWR) for current influenza A guidelines Rimexolone (Vexol Ophthalmic) [Steroid] Uses: *Postop inflammation & uveitis* Action: Steroid Dose: Adults & Peds >2 y. Uveitis: 1–2 gtt/h AM & q2h PM, taper to 1 gtt q4h; Postop: 1–2 gtt qid =2 wk Caution: [C, ?/–] Ocu- lar Infxns Disp: Susp 1% SE: Blurred vision, local irritation NIPE: Shake well, N touch eye w/ dropper; taper dose Risedronate (Actonel w/calcium) [Biphosphonate/Hormone] Uses: *Paget Dz; Rx/ prevent glucocorticoid-induced/postmenopausal osteoporosis* Action: Bisphosphonate; ↓ osteoclast-mediated bone resorption Dose: Paget Dz: 30 mg/d PO for 2 mo. Osteoporosis Rx/prevention: 5 mg daily or 35 mg qwk; 30 min before 1st food/drink of the day; stay upright for at least 30 min Ritonavir 247 after Caution: [C, ?/–] Ca supls & antacids ↓ absorption Contra: Component allergy, ↓ Ca2+, esophageal abnormalities, unable to stand/sit for 30 min, CrCl <30 mL/min Disp: Tabs 5, 30, 35, 75 mg; Risedronate 35 mg (4 tabs)/Ca carbonate 1250 mg (24 tabs) SE: HA, D, abd pain, arthralgia; flulike Sxs, rash, esophagitis, bone pain Interactions: ↓ Effects W/ antacids, ASA, Ca2+, food Labs: Interference W/ bone-imaging agents Labs: Monitor LFT, Ca2+, PO3+, K+ NIPE: EtOH intake and cigarette smoking promote osteoporosis Risperidone, oral (Risperdal, Risperdal M-Tab) [Antipsy- chotic] WARNING: ↑ mortality in elderly with dementia-related psychosis Uses: *Psychotic disorders (schizophrenia)*, dementia of the elderly, bipolar disorder, mania, Tourette disorder, autism Action: Benzisoxazole antipsychotic Dose: Adults. 0.5–6 mg PO bid; M-Tab 1–6 mg/d start 1–2 mg/d, titrate q3–7d Peds/Ado- lescents. 0.25 mg PO bid, ↑ q5–7d; ↓ start dose w/ elderly, renal/hepatic impair Caution: [C, –], ↑ BP w/ antihypertensives, clozapine Contra: Component allergy Disp: Tabs 0.25, 0.5, 1, 2, 3, 4 mg; soln 1 mg/mL, M-Tab (orally disintegrating) tabs 0.5, 1, 2, 3, 4 mg SE: Orthostatic ↑ BP, EPS w/ high dose, tachycardia, arrhythmias, sedation, dystonias, neuroleptic malignant synd, sexual dysfunction, constipation, xerostomia, blood dyscrasias, cholestatic jaundice, wt Interactions: ↑ Effects W/ clozapine, CNS depressants, EtOH; ↑ effects OF antihypertensives; ↑ effects W/ carbamazepine; ↓ effects OF levodopa Labs: ↑ LFTs, serum prolactin NIPE: ↑ Risk photosensitivity—use sunscreen, extrapyramidal effects; may alter body temp regulation; several wks to see effect; several wks for effect Risperidone, parenteral (Risperdal Constra) [Antipsychotic] WARNING: Not approved for dementia-related psychosis; ↑ mortality risk in elderly dementia pts on atypical antipsychotics; most deaths due to CV or infectious events Uses: Schizophrenia Action: Benzisoxazole antipsychotic Dose: 25 mg q2wk IM may ↑ to max 50 mg q2wk; w/ renal/hepatic impair start PO Risperdal 0.5 mg PO bid × 1 wk titrate weekly Caution: [C, –], ↑ BP w/ antihypertensives, clozapine Contra: Component allergy Disp: Inj 25, 37.5, 50 mg/vial SE: See risperidone In- teractions: ↑ Effects W/ clozapine, CNS depressants, EtOH; ↑ effects OF antihypertensives; ↓ effects W/ carbamazepine; ↑ effects OF levodopa Labs: ↑ LFTs, serum prolactin NIPE: ↑ Risk photosensitivity—use sunscreen, extrapyramidal effects; may alter body temp regulation; several wks to see effect; long-acting injection Ritonavir (Norvir) [Antiretroviral/Protease Inhibitor] WARNING: Life-threatening adverse events when used with certain nonsedating antihistamines, sedative hypnotics, antiarrhythmics, or ergot alkaloids due to inhib- ited drug metabolism Uses: *HIV* Actions: Protease inhibitor; ↓ maturation of immature noninfectious virions to mature infectious virus Dose: Adults. Initial 300 mg PO bid, titrate over 1 wk to 600 mg PO bid (titration will ↓ GI SE). Peds >1 mo. 250 mg/m2 titrate to 400 mg bid (adjust w/ amprenavir, indinavir, nelfinavir, & saquinavir); w/ food Caution: [B, +] w/ ergotamine, amiodarone, bepridil, flecainide, propafenone, quinidine, pimozide, midazolam, triazolam Contra: Component 248 Rivastigmine

Allergy Disp: Caps 100 mg; soln 80 mg/mL SE: ↑ triglycerides, ↑ LFTs, N/V/D/C, abd pain, taste perversion, anemia, weakness, HA, fever, malaise, rash, paresthesias Interactions: ↑ Effects W/ erythromycin, interleukins, grapefruit juice, food; ↑ effects OF amiodarone, astemizole, atorvastatin, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem; ↓ effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John’s wort, tobacco; ↓ effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin Labs: ↑ Serum glucose, LFTs, triglycerides, uric acid NIPE: Food ↑ absorption; use barrier contraception; disulfiram- like Rxn w/ disulfiram, metronidazole; refrigerate Rivastigmine (Exelon) [Cholinesterase Inhibitor/Anti-Alzheimer Agent] Uses: *Mild–moderate dementia in Alzheimer Dz* Action: Enhances cholinergic activity Dose: 1.5 mg bid; ↑ to 6 mg bid, w/ ↑ at 2-wk intervals (w/ food) Caution: [B, ?] w/ β-Blockers, CCBs, smoking, neuromuscular blockade, digoxin Contra: Rivastigmine or carbamate allergy Disp: Caps 1.5, 3, 4.5, 6 mg; soln 2 mg/mL SE: Dose-related GI effects, N/V/D, dizziness, insomnia, fatigue, tremor, diaphoresis, HA, wt loss (in 18–26%) Interactions: ↑ Risk OF GI bleed W/ NSAIDs; ↓ effects W/ nicotine; ↓ effects OF anticholinergics NIPE: Take w/ food; swallow caps whole, do not break/chew/crush; avoid EtOH Rivastigmine transdermal (Exelon) [Cholinesterase In- hibitor/Anti-Alzheimer Agent] Uses: *Mild/moderate Alzheimer and Parkinson disease dementia* Action: Acetylcholinesterase inhibitor Dose: Initial 4.6-mg patch/d applied to back, chest, upper arm, ↑ 9.5 mg after 4 wk if tolerated Caution: [?; ?] Sick sinus synd, conduction defects, asthma, COPD, urinary obst, Sz Contra: Hypersensitivity to rivastigmine, other carbamates Disp: Transdermal patch 5 cm2 (4.6 mg/24 h), 10 cm2 (9.5 mg/24 h) SE: N/V/D Rizatriptan (Maxalt, Maxalt MLT) [Antimigraine Agent/5-HT1 Agonist] Uses: *Rx acute migraine* Action: Vascular serotonin receptor agonist Dose: 5–10 mg PO, repeat in 2 h, PRN, 30 mg/d max Caution: [C, M] Con- tra: Angina, ischemic heart Dz, ischemic bowel Dz, hemiplegic/basilar migraine, uncontrolled HTN, ergot or serotonin 5-HT1 agonist use w/in 24 h, MAOI use w/in 14 d Disp: Tab 5, 10 mg; MLT: OD tabs 5, 10 mg. SE: Chest pain, palpitations, N, V, asthenia, dizziness, somnolence, fatigue Interactions: ↑ Vasospastic effects W/ ergots, 5-HT agonists; ↑ effects W/ MAOIs, propranolol NIPE: Treatment for migraines—not for prophylaxis Rocuronium (Zemuron) [Skeletal Muscle Relaxant] Uses: *Skeletal muscle relaxation during rapid-sequence intubation, surgery, or mechanical ventilation* Action: Nondepolarizing neuromuscular blocker Dose: Rapid sequence Rosiglitazone/Metformin 249 intubation: 0.6–1.2 mg/kg IV. Continuous inf: 5–12.5 μg/kg/min IV; adjust/titrate based on monitoring; ↓ in hepatic impair Caution: [C, ?] Aminoglycosides, vancomycin, tetracycline, polymyxin enhance blockade Contra: Component or pancuronium allergy Disp: Inj preservative free 10 mg/mL SE: BP changes, tachycardia Interactions: ↑ Effects W/ MAOIs, propranolol; ↑ vasospastic Rxn W/ ergot-containing drugs; ↑ risk of hyperreflexia, incoordination, weakness W/ SSRIs NIPE: Food delays drug action; N take >30 mg/24 h Ropinirole (Requip) [Dopamine Agonist/Anti-Parkinson Agent] Uses: *Rx of Parkinson Dz, restless leg synd* Action: Dopamine agonist Dose: Initial 0.25 mg PO tid, weekly ↑ 0.25 mg/dose, to 3 mg max, max 4 mg for RLS Caution: [C, ?/–] Severe CV, renal, or hepatic impair Contra: Compo- nent allergy Disp: Tabs 0.25, 0.5, 1, 2, 3, 4, 5 mg SE: Syncope, postural ↓ BP, N/V, HA, somnolence, dosed-related hallucinations, dyskinesias, dizziness Interac- tions: ↑ Risk of bleeding W/ ASA, NSAIDs, feverfew, garlic, ginger, horse chestnut, red clover, EtOH, tobacco; ↑ effects OF amitriptyline, Li, MTX, theophylline, warfarin; ↑ risk of photosensitivity W/ dong quai—use sunscreen, St. John’s wort; ↓ effects W/ antacids, rifampin; ↓ effects OF ACEIs, diuretics Labs: ↑ ALT, AST NIPE: Take W/ food; D/C w/ 7-d taper Rosiglitazone (Avandia) [Hypoglycemic/Thiazolidinedione] Uses: *Type 2 DM* Action: Thiazolidinedione; ↑ insulin sensitivity Dose: 4–8 mg/d PO or in 2 ÷ doses (w/o regard to meals) Caution: [C, –] w/ ESRD, CHF, edema, Contra: DKA, severe CHF, ALT >2.5 ULN Disp: Tabs 2, 4, 8 mg SE: May ↑ CV & CA risk; wt gain, hyperlipidemia, HA, edema, fluid retention, worsen CHF, hyper-/hypoglycemia, hepatic damage w/ ↑ LFTs Interactions: ↑ Risk of hypoglycemia W/ insulin, ketoconazole, oral hypoglycemics, fenugreek, garlic, ginseng, glucomannan; ↓ effects OF OCPs Labs: ↑ ALT, total cholesterol, LDL, HDL, ↓ HMG, Hct NIPE: Use barrier contraception; not recomended in class III, IV heart Dz Rosiglitazone/Metformin (Avandamet) [Hypoglycemic/Thi- azolidinedione & Biguanide] WARNING: Associated w/ lactic acidosis Uses: Type 2 DM Action: ↓ Hepatic glucose production & intestinal absorption of glucose; ↑ insulin sensitivity Dose: Adults. Initial: 2 mg/500 mg PO OD or bid with AM and PM meal; increase by 2 mg/500 mg/d after 4 wk; max 8 mg/2000 mg/d. Peds. Not recommended. Caution: [C, –] Hold dose before & 48 h after ionic contrast; not for DKA; w/ ESRD (renal elimination) Contra: SCr >1.4 in females or >1.5 in males; hypoxemic conditions (eg, acute CHF/sepsis); active liver Dz; metabolic acidosis Disp: Tabs Rosiglitazone/Metformin: (mg/mg) 2/500, 4/500, 2/1000, 4/1000 SE: Wt gain, hyperlipidemia, HA, edema, fluid retention, exacerbated CHF, hyper-/hypoglycemia, hepatic damage, anorexia, N/V, rash, lactic acidosis (rare, but serious) Interactions: ↑ Risk of hypoglycemia W/ insulin, ketoconazole, fenugreek, garlic, ginseng, glucomannan; ↑ effects W/ amiloride, cimetidine, digoxin, furosemide, MAOIs, morphine, procainamide, quinidine, quinine, 250 Rosuvastatin ranitidine, triamterene, trimethoprim, vancomycin; ↓ effects W/ corticosteroids, CCBs, diuretics, estrogens, INH, OCPs, phenothiazine, phenytoin, sympathomimetics, thyroid drugs, tobacco; ↓ effects OF OCPs Labs: ↑ LFTs, lipids, SCr ↓ HMG, Hct; monitor LFTs, SCr baseline & periodically NIPE: Use barrier contraception; take w/ food; N dehydration, EtOH, before surgery Rosuvastatin (Crestor) [Antilipemic/HMG-CoA Reductase Inhibitor] Uses: *Rx primary hypercholesterolemia & mixed dyslipidemia* Action: HMG-CoA reductase inhibitor Dose: 5–40 mg PO daily; max 5 mg/d w/cyclosporine, 10 mg/d w/gemfibrozil or CrCl <30 mL/min (avoid Al-/Mg-based antacids for 2 h after) Caution: [X, ?/–] Contra: Active liver Dz, unexplained ↑ LFT Disp: Tabs 5, 10, 20, 40 mg SE: Myalgia, constipation, asthenia, abd pain, N, myopathy, rarely rhabdomyolysis Interactions: ↑ Effects OF warfarin; ↑ risk of myopathy W/ cyclosporine, fibrates, niacin, statins Labs: ↑ Warfarin; ↑ LFTs; monitor LFTs at baseline, 12 wk, then q6mo; ↑ urine protein, HMG NIPE: N PRG or breast-feeding; ↓ dose in Asian patients Rotavirus vaccine, live, oral, pentavalent (RotaTeq) [Vac- cine] Uses: *Prevent rotavirus gastroenteritis* Action: Active immunization Dose: Peds. Single dose PO at 2, 4, 6 mo Caution: [?, ?] Disp: Oral susp 2-mL single-use tubes SE: D, V Interactions: ↓ Effects W/ immunosuppressants such as irradiation, chemotherapy or high dose steroids NIPE: Begin series by 12 wk and conclude by 32 wk of age; N take with oral polio vaccine Salmeterol (Serevent Diskus) [Bronchodilator/Sympath- β ↑ omimetic] WARNING: Long-acting 2-agonists, such as salmeterol, may the risk of asthma-related death. Should not be used alone, only as additional therapy for patients not controlled on other asthma medications Uses: *Asthma, exer- β cise-induced asthma, COPD* Action: Sympathomimetic bronchodilator, 2-agonist Dose: Adults & Peds = 12 y. 1 diskus-dose inhaled bid Caution: [C, ?/–] Contra: Acute asthma; w/in 14 d of MAOI Disp: 50 μg/dose, dry powder discus, metered dose inhaler, 21 μg/activation SE: HA, pharyngitis, tachycardia, arrhythmias, nervousness, GI upset, tremors Interactions: ↑ CV Effects W/ MAOIs, TCAs; ↓ Effects W/ BBs Labs:↑ Glucose; ↓ serum K+ NIPE: Shake canister before use, inhale q12h, not for acute exacerbations; also prescribe short-acting β-agonist Saquinavir (Fortovase, Invirase) [Antiretroviral/Protease Inhibitor] WARNING: Invirase and Fortovase not bioequivalent/interchangeable; must use Invirase in combo w/ ritonavir, which provides saquinavir plasma levels = to those w/ Fortovase Uses: *HIV Infxn* Action: HIV protease inhibitor Dose: 1200 mg PO tid w/in 2 h pc (dose adjust w/ ritonavir, delavirdine, lopinavir, & nelfinavir) Caution: [B, +] w/ ketoconazole, statins, sildenafil Contra: w/ rifampin, severe hepatic impair, allergy, sun exposure w/o sunscreen/clothing, triazolam, midazolam, ergots, Disp: Caps 200, tabs 500 mg SE: Dyslipidemia, lipodystrophy, rash, hyperglycemia, GI upset, weakness Interactions: ↑ Risk of life- threatening arrhythmias W/ amiodarone, astemizole, bepridil, cisapride, flecainide, Secobarbital 251 propafenone, pimozide, quinidine, terfenadine; ↑ risk of myopathy W/ HMG-CoA reductase inhibitors; ↑ risk of peripheral vasospasm & ischemia W/ ergot derivatives; ↑ effects W/ delavirdine, indinavir, ketoconazole, macrolide antibiotics, nelfinavir, ritonavir, grapefruit juice, garlic, St. John’s wort, food; ↑ effects OF amitriptyline, benzodiazepines, CCB, lovastatin, macrolide antibiotics, phenytoin, sildenafil, simvastatin, terfenadine, TCAs, verapamil; ↓ effects W/ barbiturates, carbamazepine, dexamethasone, efavirenz, phenytoin, rifabutin, rifampin, St. John’s wort; ↓ effects OF OCPs Labs: ↑ LFTs, ↓ neutrophils NIPE: Take 2 h after meal; use barrier contraception; ↑ risk of photosensitivity—use sunscreen Sargramostim [GM-CSF] (Leukine) [Hematopoietic Drug/ Colony-Stimulating Factor] Uses: *Myeloid recovery following BMT or chemo* Action: Recombinant GF, activates mature granulocytes & macrophages Dose: Adults & Peds. 250 μg/m2/d IV for 21 d (BMT) Caution: [C, ?/–] Lithium, corticosteroids Contra: >10% blasts, allergy to yeast, concurrent chemo/RT Disp: Inj 250, 500 μg SE: Bone pain, fever, ↓ BP, tachycardia, flushing, GI upset, myalgia Interactions: ↑ Effects W/ corticosteroids, Li Labs: ↑ BUN, LFTs NIPE: N Exposure to Infxn; rotate inj sites; use APAP PRN for pain Scopolamine, Scopolamine Transdermal and Ophthalmic (Scopace, Transderm-Scop) [Antiemetic/Antivertigo/Anti- cholinergic] Uses: *Prevent N/V associated w/ motion sickness, anesthesia, opiates; mydriatic*, cycloplegic, Rx uveitis & iridocyclitis Action: Anticholiner- gic, inhibits iris and ciliary bodies, antiemetic Dose: 1 mg/ 72 h, 1 patch behind ear q3d; apply >4 h before exposure; cycloplegic 1–2 gtt 1 h pre, uveitis 1–2 gtt up to qid max; ↓ in elderly Caution: [C, +] w/ APAP, levodopa, ketoconazole, digitalis, KCl Contra: NAG, GI, or GU obst, thyrotoxicosis, paralytic ileus Disp: Patch 1.5 mg, (releases 1 mg over 72 h), ophth 0.25% SE: Xerostomia, drowsiness, blurred vision, tachycardia, constipation Interactions: ↑ Effects W/ antihistamines, antidepressants, disopyramide, opioids, phenothiazine, quinidine, TCAs, EtOH NIPE: Do not blink excessively after eye gt, wait 5 min before dosing other eye; antiemetic activity w/ patch requires several hours; N D/C abruptly; wash hands after applying patch; may cause heat intolerance Secobarbital (Seconal) [C-II] [Anticonvulsant, Sedative/ Hypnotic/Barbiturate] Uses: *Insomnia, short-term use*, preanesthetic agent Action: Rapid-acting barbiturate Dose: Adults. 100–200 mg hs, 100–300 mg preop. Peds. 2–6 mg/kg/dose, 100 mg/max, ↓ in elderly Caution: [D, +] CYP2C9, 3A3/4, 3A5/7 inducer (Table 11); ↑ tox w/ other CNS depressants Contra: Por- phyria, w/ voriconazole, PRG Disp: Caps 50, 100 mg SE: Tolerance in 1–2 wk; resp depression, CNS depression, porphyria, photosens Interactions: ↑ Effects W/ MAOIs, valproic acid, EtOH, kava kava, valerian; ↑ effects OF meperidine; ↓ effects OF anticoagulants, BBs, CCBs, CNS depressants, chloramphenicol, corticosteroids, cyclosporine, digitoxin, disopyramide, doxycycline, estrogen, griseofulvin, methadone, neuroleptics, OCPs, propafenone, quinidine, tacrolimus, theophylline 252 Selegiline, Oral

NIPE: Tolerance in 1–2 wk; photosensitivity; N PRG, breast-feeding; use barrier contraception Selegiline, Oral (Eldepryl, Zelapar) [Anti-Parkinson Agent/ MAOB Inhibitor] Uses: * Parkinson Dz* Action: MAOI Dose: 5 mg PO bid; 1.25–2.5 OD tabs PO qAM (before breakfast w/o Liq) 2.5 mg/d max; ↓ in elderly Caution: [C, ?] w/ drugs that induce CYP3A4 (Table 11) (eg, phenytoin, carbamazepine, nafcillin, phenobarbital, and rifampin); avoid w/ antidepressants Contra: w/ meperidine, MAOI, dextromethorphan, general anesthesia w/in 10 d, pheochromocytoma Disp: Tabs/caps 5 mg; OD Tabs 1.25 mg SE: N, dizziness, orthostatic ↓ BP, arrhythmias, tachycardia, edema, confusion, xerostomia Inter- actions: ↑ Risk of serotonin synd W/ dextroamphetamine, dextromethorphan, fenfluramine, meperidine, methylphenidate, sibutramine, venlafaxine; ↑ risk of hypertension W/ dextroamphetamine, levodopa, methylphenidate, SSRIs, tyramine- containing foods, EtOH, ephedra, ginseng, ma-huang, St. John’s wort Labs: + for amphetamine on urine drug screen NIPE: ↓ Carbidopa/levodopa if used in combo; see transdermal form Selegiline, Transdermal (Emsam) [Anti-Parkinson Agent/ MAO B Inhibitor] WARNING: May ↑ risk of suicidal thinking and behavior in children and adolescents with major depression disorder Uses: *Depression* Action: MAOI Dose: Adults. Apply patch daily to upper torso, upper thigh, or outer upper arm Contra: Tyramine-containing foods w/ 9- or 12-mg doses; serotonin-sparing agents Caution: [C, –] ↑ Carbamazepine and oxcarbazepine levels Disp: XR Patches 6, 9, 12 mg SE: Local Rxns requiring topical steroids; HA, insomnia, orthostatic, ↓ BP, serotonin synd, suicide risk Interactions: ↑ Risk of serotonin synd W/ dextroamphetamine, dextromethorphan, fenfluramine, meperidine, methylphenidate, sibutramine, venlafaxine; ↑ risk of hypertension W/ dextroamphetamine, levodopa, methylphenidate, SSRIs, tyramine-containing foods, EtOH, ephedra, ginseng, ma-huang, St. John’s wort; NIPE: N EtOH & tyramine- containing foods; rotate site; see oral form Selenium Sulfide (Exsel Shampoo, Selsun Blue Shampoo, Selsun Shampoo) [Antiseborrheic] Uses: *Scalp seborrheic dermatitis*, scalp itching & flaking due to *dandruff*; tinea versicolor Action: Antisebor- rheic Dose: Dandruff, seborrhea: Massage 5–10 mL into wet scalp, leave on 2–3 min, rinse, repeat; use 2 × wk, then once q1–4wk PRN. Tinea versicolor: Apply 2.5% daily × on area & lather w/ small amounts of water; leave on 10 min, then rinse Caution: [C, ?] Contra: Open wounds Disp: Shampoo [OTC]; 2.5% lotion SE: Dry or oily scalp, lethargy, hair discoloration, local irritation NIPE: N Use on ex- coriated skin; may cause reversible hair loss; rinse thoroughly after use; DO NOT use more than 2 ×/wk Sertaconazole (Ertaczo) [Antifungal] Uses: *Topical Rx interdigital tinea pedis* Action: Imidazole antifungal. Spectrum: T. rubrum, T. mentagrophytes, E. floccosum Dose: Adults & Peds > 12. Apply between toes & immediate Sildenafil 253 surrounding healthy skin bid × 4 wk Caution: [C, ?] Contra: Component allergy Disp: 2% cream SE: Contact dermatitis, dry/burning skin, tenderness NIPE: Use in immunocompetent pts; not for oral, intravag, ophthalmic use; avoid occlusive dressings; avoid contact with mucous membranes Sertraline (Zoloft) [Antidepressant/SSRI] WARNING: Closely monitor pts for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression, panic disorders, obsessive–compulsive disorder (OCD), posttraumatic stress disorders (PTSD)*, social anxiety disorder, eating disorders, premenstrual disorders Action: ↓ Neuronal uptake of serotonin Dose: Adults. De- pression: 50–200 mg/d PO. PTSD: 25 mg PO daily × 1 wk, then 50 mg PO daily, 200 mg/d max Peds. 6–12 y: 25 mg PO daily; 13–17 y: 50 mg PO daily Caution: [C, ?/–] w/ haloperidol (serotonin synd), sumatriptan, linezolid, hepatic impair Contra: MAOI use w/in 14 d; concomitant pimozide Disp: Tabs 25, 50, 100, 150, 200 mg; 20 mg/mL oral SE: Activate manic/hypomanic state, ↓ wt, insomnia, somnolence, fatigue, tremor, xerostomia, N/D, dyspepsia, ejaculatory dysfunction, ↓ libido, hepatotox Interactions: ↑ Effects W/ cimetidine, tryptophan, St. John’s wort; ↑ effects OF benzodiazepines, phenytoin, TCAs, warfarin, EtOH; ↑ risk of serotonin synd W/ MAOIs Labs: ↑ LFTs, triglycerides, ↓ uric acid NIPE: N D/C abruptly; take w/o regard to food Sevelamer (Renagel) [Phosphate Binder] Uses: *↓ Serum phosphorus in ESRD* Action: Binds intestinal PO3+ Dose: 2–4 caps PO tid w/ meals; adjust based on PO3+, max 4 g/dose Caution: [C, ?] Contra: Hypophosphatemia, Bowel obst Disp: Caps 403 mg, tabs 400, 800 mg SE: BP changes, N/V/D, dyspepsia, thrombosis Notes: 800 mg sevelamer = 667 mg Ca acetate Interactions: ↓ Effects OF antiarrhythmics, anticonvulsants, ciprofloxacin when given W/ sevelamer Labs: ↑ alk phosp NIPE: Must be admin with meals; take daily multivitamin, may ↓ fat-soluble vitamin absorption; take 1 h before or 3 h after other meds; do not open or chew capsules Sibutramine (Meridia) [C-IV] [Anorexic/CNS Stimulant] Uses: *Obesity* Action: Blocks uptake of norepinephrine, serotonin, dopamine Dose: 10 mg/d PO, may ↓ to 5 mg after 4 wk Caution: [C, –] w/ SSRIs, lithium, dextromethorphan, opioids Contra: MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp: Caps 5, 10, 15 mg SE: HA, insomnia, xerostomia, constipation, rhinitis, tachycardia, HTN Interactions: ↑ Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tromethorphan, tryptophan, zolmitriptan, St. John’s wort; ↓ effects W/ cimetidine, erythromycin, ketoconazole; ↑ CNS depression W/ EtOH Labs: ↑ LFTs NIPE: N EtOH; take early in the day to avoid insomnia; use w/ low-calorie diet, monitor BP & HR Sildenafil (Viagra, Revatio) [Vasodilator/PDE 5 Inhibitor] Uses: Viagra: *Erectile dysfunction*, Revatio: *Pulm artery HTN* Action: ↓ Phosphodiesterase type 5 (responsible for cGMP breakdown); ↑ cGMP activity to 254 Silver Nitrate relax smooth muscles & ↑ flow to corpus cavernosum and pulm vasculature; ? antiproliferative on pulm artery smooth muscle Dose: ED: 25–100 mg PO 1 h before sexual activity, max 1 × d; ↓ if >65 y; avoid fatty foods w/ dose; Revatio Pulm HTN: 20 mg PO tid Caution: [B, ?] CYP3A4 inhibitors (Table 11) Contra: w/ nitrates or if sex activity not advised; retinitis pigmentosa; hepatic/severe renal impair Disp: Tabs (Viagra) 25, 50, 100 mg, tabs (Revatio) 20 mg SE: HA; flushing; dizziness; blue haze visual change, hearing loss Interactions: ↑ Effects W/ amlodipine, cimetidine, erythromycin, indinavir, itraconazole, ketoconazole, nelfinavir, protease inhibitors, ritonavir, saquinavir, grapefruit juice; ↑ risk of hypotension W/ amlodipine, antihypertensives, nitrates; ↓ effects W/ rifampin NIPE: High-fat food delays absorption; ↑ risk OF cardiac arrest if used W/ nitrates; cardiac events in absence of nitrates debatable Silver Nitrate (Dey-Drop, others) [Antiseptic/Astringent] Uses: *Removal of granulation tissue & warts; prophylaxis in burns* Action: Caustic antiseptic & astringent Dose: Adults & Peds. Apply to moist surface 2–3 × wk for several wk or until effect Caution: [C, ?] Contra: Do not use on broken skin Disp: Topical impregnated applicator sticks, soln 0.5, 10, 25, 50%; ophth 1% amp; topical ointment 10% SE: May stain tissue black, usually resolves; local irritation, methemoglobinemia NIPE: D/C if redness or irritation develop; no longer used in US for newborn prevention of GC conjunctivitis Silver Sulfadiazine (Silvadene, Others) [Antibiotic] Uses: *Prevention & Rx of Infxn in 2nd- & 3rd-degree burns* Action: Bactericidal Dose: Adults & Peds. Aseptically cover the area w/ 1/16-in. coating bid Caution: [B unless near term, ?/–] Contra: Infants <2 mo, PRG near term Disp: Cream 1% SE: Itching, rash, skin discoloration, blood dyscrasias, hepatitis, allergy Interac- tions: May inactivate topical proteolytic enzymes; Labs: ↓ WBCs; monitor LFTs, BUN, Cr NIPE: Photosensitivity—use sunscreen; systemic absorption w/ extensive application Simethicone (Mylicon, Others) [OTC] [Antiflatulent] Uses: Flatulence Action: Defoaming, alters gas bubble surface tension action Dose: Adults & Peds. >2 y: 40–125 mg PO pc & hs PRN; 500 mg/D max; <2 y: 20 mg PO qid PRN, 2–12 y: 40 mg PO qid PRN, >12 y–adult Caution: [C, ?] Contra: GI Intestinal perforation or obst Disp: [OTC] Tabs 80, 125 mg; caps 125 mg; Soft- gels 125, 166, 180 mg, susp 40 mg/0.6 mL, Chew tabs 80, 125 mg SE: N/D Inter- actions: ↑ Effects OF topical proteolytic enzymes NIPE: Available in combo products OTC Simvastatin (Zocor) [Antilipemic/HMG-CoA Reductase In- hibitor] Uses: ↓ Cholesterol Action: HMG-CoA reductase inhibitor Dose: Adult. 5–80 mg PO; w/ meals; ↓ in renal insuff Peds. 10–17 y: 10 mg, 40 mg/daily max. Caution: [X, –] Avoid concurrent use of gemfibrozil Contra: PRG, liver Dz Disp: Tabs 5, 10, 20, 40, 80 mg SE: HA, GI upset, myalgia, myopathy (muscle pain, tenderness or weakness with creatine kinase 10 × ULN), hepatitis Interactions: Sitagliptin/Metformin 255

↑ Effects OF digoxin, warfarin; ↑ risk of myopathy/rhabdomyolysis W/ amiodarone, cyclosporine, CYP3A4 inhibitors, fibrates, HIV protease inhibitors, macrolides, niacin, verapamil, grapefruit juice; ↓ effects W/ cholestyramine, colestipol, fluvastatin, isradipine, propranolol Labs: ↑ LFTs, monitor NIPE: Take w/ food and in the evening; N PRG, breast-feeding; combo with ezetimibe/simvastatin Sirolimus [Rapamycin] (Rapamune) [Immunosuppressant] WARNING: Use only by health care provider experienced in immunosuppression; immunosuppression w/ lymphoma ↑ Infxns risk; do not use in lung transplant (fatal bronchial anastomotic dehiscence) Uses: *Prophylaxis of organ rejection in new Tx pts* Action: ↓ T-lymphocyte activation Dose: Adults >40 kg. 6 mg PO on day 1, then 2 mg/d PO. Adults <40 kg & Peds = 13 y. 3 mg/m2 load, then 1 2 mg/m /d (in H2O/OJ; no grapefruit juice w/ sirolimus); take 4 h after cyclosporine; ↓ in hepatic impair Caution: [C, ?/–] Grapefruit juice, ketoconazole Contra: Com- ponent allergy Disp: Soln 1 mg/mL, tab 1, 2 mg SE: HTN, edema, CP, fever, HA, insomnia, acne, rash, ↑ cholesterol, GI upset, ↑↓ K+, Infxns, blood dyscrasias, arthralgia, tachycardia, renal impair, hepatic artery thrombosis, graft loss & death in de novo liver transplant (↑ hepatic artery thrombosis), delayed wound healing Notes: Levels not needed except in liver failure (trough 9–17 ng/mL) Interactions: ↑ Effects W/ azole antifungals, cimetidine, cyclosporine, diltiazem, macrolides, nicardipine, protease inhibitors, verapamil, grapefruit juice; ↓ effects W/ carbamazepine, phenobarbital, phenytoin, rifabutin, rifapentine, rifampin; ↓ effects OF live virus vaccines Labs: ↑ LFTs, BUN, Cr, cholesterol, triglycerides NIPE: Take w/o regard to food; N PRG while taking drug and for 12 wk after drug D/C Sitagliptin (Januvia) [Hypoglycemic/DPP-4 Inhibitor] Uses: *Type 2 DM* Action: Dipeptidyl peptidase-4 (DDP-4) inhibitor, ↑ insulin synth/release Dose: 100 mg PO daily; ↓ w/ renal impair Caution: [B; ?] Con- tra: DKA, type 1 DM Disp: Tabs 25, 50, 100 SE: URI, HA, D, abd pain, arthralgia Interactions: Monitor digoxin levels Labs: Monitor LFTs, BUN/Cr NIPE: N Children <18 y; monitor renal function; start drug at low dose and periodically increase Sitagliptin/Metformin (Janumet) [Hypoglycemic/DPP-4 Inhibitor/Biguanide] WARNING: Associated w/ lactic acidosis Uses: *Adjunct to diet and exercise in type 2 DM * Action: See individual agents Dose: 1 tab PO bid, titrate; 100 mg sitaglipin & 2000 mg metformin/d max; w/ meals Caution: [B, ?/–] Contra: Type 1 DM, DKA Disp: Tabs 50/500, 50/1000 (mg/mg) SE: Nasopharyngitis, N/V/D, flatulence, abd discomfort, dyspepsia, asthenia, HA Interactions: ↑ Effects W/ amiloride, cimetidine, digoxin, furosemide, MAOIs, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin; ↓ effects W/ corticosteroids, CCBs, diuretics, estrogens, INH, OCPs, phenothiazine, phenytoin, sympathomimetics, thyroid drugs, tobacco; monitor digoxin levels Labs: Monitor LFTs, BUN/Cr NIPE: N Children <18 y; monitor renal function; start drug at low dose & periodically increase; hold w/ contrast study 256 Smallpox Vaccine

Smallpox Vaccine (Dryvax) [Vaccine] WARNING: Acute myocarditis and other infectious complications possible; contra in immunocompromised, eczema or exfoliative skin conditions, infants <1 y Uses: Immunization against smallpox(Variola virus) Action: Active immunization (live attenuated cow- pox virus) Dose: Adults (routine nonemergency) or all ages (emergency). 2–3 punctures w/ bifurcated needle dipped in vaccine into deltoid, posterior triceps muscle; site for Rxn in 6–8 d; if major Rxn, site scabs, & heals, leaving scar; if mild/equivocal Rxn, repeat w/ 15 punctures Caution: [X, N/A] Contra: Nonemer- gency use: Febrile illness, immunosuppression, h/o eczema & their household contacts. Emergency: No absolute contraindications Disp: Vial for recons: 100 million pock-forming units/mL SE: Malaise, fever, regional lymphadenopathy, encephalopathy, rashes, spread of inoculation to other sites administered; Stevens–Johnson synd, eczema vaccinatum w/ severe disability NIPE: Virus transmission possible until scab separates from skin (14–21 d); avoid infant contact for 14 d; intradermal use only Sodium Bicarbonate [NaHCO3] [Antacid/Alkalinizing Agent] Uses: *Alkalinization of urine*, RTA, *metabolic acidosis, ↑ K+, TCA OD* Action: Alkalinizing agent Dose: Adults. Cardiac arrest: Initiate ventilation, 1 mEq/kg IV bolus; repeat 1/2 dose q10 min PRN (ECC 2005); Metabolic acidosis: 2–5 mEq/kg IV over 8 h & PRN based on acid–base status. Alkalinize urine: 4 g (48 mEq) PO, then 1–2 g q4h; adjust based on urine pH; 2 amp/1 L D5W at 100–250 mL/h IV, monitor urine pH & serum bicarbonate. Chronic renal failure: 1–3 mEq/kg/d. Distal RTA: 1 mEq/kg/d PO. Peds > 1 y. Cardiac arrest: See Adult dosage. Peds < 1 y. ECC: Initiate ventilation, 1:1 dilution 1 mEq/mL dosed 1 mEq/kg IV; can repeat w/ 0.5 mEq/kg in 10 min × 1 or based on acid–base status. Chronic renal failure: See adult dosage. Distal RTA: 2–3 mEq/kg/d PO. Proximal RTA: 5–10 mEq/kg/d; titrate based on serum bicarbonate. Urine alkalinization: 84–840 mg/kg/d (1–10 mEq/kg/d) in ÷ doses; adjust based on urine pH Caution: [C, ?] Contra: Alkalosis, ↑ Na+, severe pulm edema, ↓ Ca2+ Disp: Powder, tabs; 300 mg = 3.6 mEq; 325 mg = 3.8 mEq; 520 mg = 6.3 mEq; 600 mg = 7.3 mEq; 650 mg = 7.6 mEq; inj 1 mEq/1 mL, 4.2% (5 mEq/10 mL), 7.5% (8.92 mEq/mL), 8.4% (10 mEq/10 mL) vial or amp SE: Belching, edema, flatulence, ↑ Na+, metabolic alkalosis Notes: 1 g neutralizes 12 mEq of acid; 50 mEq bicarb = 50 mEq Na; can ↑ make 3 amps in 1 L D5W to = D5NS w/ 150 mEq bicarb Interactions: Effects OF anorexiants, amphetamines, ephedrine, flecainide, mecamylamine, pseudoephedrine, quinidine, sympathomimetics; ↓ effects OF Li, MTX, salicylates, tetracyclines Labs: ↑ K+, lactate NIPE: N Take w/in 2 h of other drugs; ↑ risk of milk-alkali syndrome w/ long-term use or when taken w/ milk Sodium Citrate/Citric Acid (Bicitra) [Alkalinizing Agent] Uses: *Chronic metabolic acidosis, alkalinize urine; dissolve uric acid & cysteine stones* Action: Urinary alkalinizer Dose: Adults. 2–6 tsp (10–30 mL) diluted in 1–3 oz H2O pc & hs. Peds. 1–3 tsp (5–15 mL) diluted in 1–3 oz H2O pc & hs; best Solifenacin 257 after meals Caution: [C, +] Contra: Al-based antacids; severe renal impair or Na- restricted diets Disp: 15- or 30-mL unit dose: 16 (473 mL) or 4 (118 mL) fl oz SE: Tetany, metabolic alkalosis, ↑ K+, GI upset; avoid use of multiple 50-mL amps; can cause ↑ Na+/hyperosmolality Notes: 1 mL = 1 mEq Na & 1 mEq bicarb Interactions: ↑ Effects OF amphetamines, ephedrine, flecainide, pseudoephedrine, quinidine; ↓ effects OF barbiturates, chlorpropamide, Li, salicylates NIPE: Dilute W/ water; Sodium Oxybate (Xyrem) [C-III] [Inhibitory Neurotransmit- ter] WARNING: Known drug of abuse even at recommended doses; confusion, depression, resp. depression may occur Uses: *Narcolepsy-associated cataplexy* Action: Inhibitory neurotransmitter Dose: Adults & Peds = 16 y. 2.25 g PO qhs, 2nd dose 2.5–4 h later; may ↑ 9 g/d max Caution: [B, ?/–] Contra: Succinic semi- aldehyde dehydrogenase deficiency; potentiates EtOH Disp: 500 mg/mL 180-mL PO soln SE: Confusion, depression, ↓ diminished level of consciousness, incontinence, significant V, resp depression, psychiatric Sxs Interactions: ↑ Risk of CNS depression W/ sedatives, hypnotics, EtOH NIPE: Dilute w/ 2 oz water, N eat w/in 2 h of taking this drug; may lead to dependence; synonym for γ-hydroxybutyrate (GHB), abused as a “date rape drug”; controlled distribution (prescriber & pt regis- tration); must be administered when pt in bed Sodium Phosphate (Visicol) [Laxative] Uses: *Bowel prep prior to colonoscopy* Action: Hyperosmotic laxative Dose: 3 tabs PO w/ at least 8 oz clear Liq every 15 min (20 tabs total night before procedure; 3–5 h before colonoscopy, repeat) Caution: [C, ?] Renal impair, electrolyte disturbances Con- tra: Megacolon, bowel obst, CHF, ascites, unstable angina, gastric retention, bowel perforation, colitis, hypomotility. Disp: Tablets 0.398, 1.102 g SE: ↑ QT, ↑ PO3,↓ K+, Na, D, flatulence, cramps, abd bloating/pain Interactions: May bind with Al- & Mg-containing antacids and sucralfate; ↑ risk OF hypoglycemia W/ bisphosphonates; ↓ absorption OF other meds Labs: Monitor electrolytes NIPE: Drink clear Liq 12 h before start of this med; N take w/ drugs that prolong QT interval, N take other laxatives Sodium Polystyrene Sulfonate (Kayexalate) [Potassium Re- moving Resin] Uses: *Rx of ↑ K+* Action: Na+/K+ ion-exchange resin Dose: Adults. 15–60 g PO or 30–60 g PR q6h based on serum K+. Peds. 1 g/kg/dose PO or PR q6h based on serum K+ (given w/ agent, eg, sorbitol, to promote movement through the bowel) Caution: [C, M] Contra: ↑ Na+ Disp: Powder; susp 15 g/ 60 mL sorbitol SE: ↑ Na+, ↓ K+, Na retention, GI upset, fecal impaction Interac- tions: ↑ Risk of systemic alkalosis W/ Ca- or Mg-containing antacids NIPE: Mix W/ chilled fluid other than OJ; enema acts more quickly than PO; PO most effective Solifenacin (VESIcare) [Antispasmodic/Muscarinic Receptor Antagonist] Uses: *OAB* Action: Antimuscarinic, ↓ detrusor contractions Dose: 5 mg PO daily, 10 mg/d max; ↓ w/ renal/hepatic impair Caution: [C, ?/–] Bladder outflow or GI obst, ulcerative colitis, MyG, renal/hepatic impair, QT 258 Sorafenib prolongation risk Contra: NAG, urinary/gastric retention Disp: Tabs 5, 10 mg SE: Constipation, xerostomia, dyspepsia, blurred vision Interactions:↑ Effects OF azole antifungals & other CYP3A4 inhibitors; ↑ risk OF prolonged QT interval W/ amiodarone, amitriptyline, bepridil, disopyramide, erythromycin, gatifloxacin, haloperidol, imipramine, moxifloxacin, quinidine, pimozide, procainamide, sparfloxacin, thioridazine; other drugs that prolong QT Labs: Monitor BUN, CR, ↑ LFTs NIPE: Take w/ or w/o food, swallow whole W/ H2O; do not dose w/ severe renal/moderate hepatic impair Sorafenib (Nexavar) [Antineoplastic/Kinase Inhibitor] Uses: *Advanced RCC* met liver CA Action: Kinase inhibitor Dose: Adults. 400 mg PO bid on empty stomach Caution: [D, –] w/ irinotecan, doxorubicin, warfarin; avoid conception (male/female) Disp: Tabs 200 mg SE: Hand–foot synd; treatment-emergent hypertension; bleeding, ↑ INR, cardiac infarction/ischemia; ↑ pancreatic enzymes, hypophosphatemia, lymphopenia, anemia, fatigue, alopecia, pruritus, D, GI upset, HA, neuropathy NIPE: Monitor BP 1st 6 wk; may require ↓ dose (daily or every other day); impaired metabolism w/ Asian descent; unknown effect on wound healing, D/C before major surgery Sorbitol (generic) [Laxative] Uses: *Constipation* Action: Laxative Dose: 30–60 mL PO of a 20–70% soln PRN Caution: [B, +] Contra: Anuria Disp: Liq 70% SE: Edema, electrolyte losses, lactic acidosis, GI upset, xerostomia NIPE: N Use unless soln clear; may be vehicle for many Liq formulations (eg, zinc, Kayexalate) Sotalol (Betapace) [Antiarrhythmic, Antihypertensive/BB] WARNING: Monitor pts for 1st 3 d of Rx to ↓ risks of arrhythmia Uses: *Ventric- ular arrhythmias, AF* Action: β-adrenergic-blocking agent Dose: Adults. 80 mg PO bid; may be ↑ to 240–320 mg/d Peds. Neonates: 9 mg/m2 tid. 1–19 mo: 20.4 mg/m2 tid. 20–23 mo: 29.1 mg/m2 tid; = >2 y: 30 mg/m2 tid; to max dose of 90 mg/m2 tid ↓ w/ renal impair Caution: [B (1st tri) (D if 2nd or 3rd tri), +] Contra: Asthma, COPD, bradycardia, ↑ prolonged QT interval, 2nd- or 3rd-degree heart block w/o pacemaker, cardiogenic shock, uncontrolled CHF, CrCl <40 mL/min Disp: Tabs 80, 120, 160, 240 mg SE: Bradycardia, CP, palpitations, fatigue, dizziness, weakness, dyspnea Interactions: ↑ Effects W/ ASA, antihypertensives, nitrates, OCPs, fluoxetine, prazosin, sulfinpyrazone, verapamil, EtOH; ↑ risk of prolonged QT interval W/ amiodarone, amitriptyline, bepridil, disopyramide, erythromycin, gatifloxacin, haloperidol, imipramine, moxifloxacin, quinidine, pimozide, procainamide, sparfloxacin, thioridazine; ↑ effects OF lidocaine; ↓ effects W/ antacids, clonidine, NSAIDs, thyroid drugs; ↓ effects OF hypoglycemics, terbutaline, theophylline Labs: ↑ BUN, serum glucose, triglycerides, K+, uric acid NIPE: May ↑ sensitivity to cold; D/C MAOIs 14 d before drug; take w/o food; Be- tapace should not be substituted for Betapace AF because of differences in labeling Sotalol (Betapace AF) [Antiarrhythmic, Antihypertensive/BB] WARNING: To minimize risk of induced arrhythmia, pts initiated/reinitiated on Betapace AF should be placed for a minimum of 3 d (on their maint dose) in a Stavudine 259 facility that can provide cardiac resuscitation, continuous ECG monitoring, & cal- culations of CrCl; Betapace should not be substituted for Betapace AF because of labeling differences Uses: *Maintain sinus rhythm for symptomatic A fib/flutter* Action: β-Adrenergic-blocking agent Dose: Adults. Initial CrCl >60 mL/min: 80 mg PO q12h. CrCl 40–60 mL/min: 80 mg PO q24h; ↑ to 120 mg during hospitalization; monitor QT interval 2–4 h after each dose, w/ dose reduction or D/C if QT interval >500 ms. Peds. Neonates: 9 mg/m2 tid. 1–19 mo: 20 mg/m2 tid. 20–23 mo: 29.1 mg/m2 tid. =2 y: 30 mg/m2 tid; can double all doses as max daily dose; allow ≈ 36 h between dosage titrations Caution: [B (1st tri; D if 2nd or 3rd tri), +] if converting from previous antiarrhythmic therapy Contra: Asthma, bradycardia, prolonged QT interval, 2nd- or 3rd-degree heart block w/o pacemaker, cardiogenic shock, uncontrolled CHF, CrCl <40 mL/min Disp: Tabs 80, 120, 160 mg SE: Bradycardia, CP, palpitations, fatigue, dizziness, weakness, dyspnea Interactions: ↑ Risk of prolonged QT interval W/ amiodarone, amitriptyline, bepridil, disopyramide, erythromycin, gatifloxacin, haloperidol, imipramine, moxifloxacin, quinidine, pimozide, procainamide, sparfloxacin, TCAs, thioridazine; ↑ effects W/ general anesthesia, phenytoin administered IV, verapamil ↑ effects OF insulin, oral hypoglycemics; ↑ risk of hypotension W/ antihypertensives, ASA, bismuth sub-salicylate, Mg salicylate, sulfinpyrazone, nitrates, OCPs, EtOH; ↑ CV reactions CCB, digoxin; ↑ risk OF severe HTN if used w/in 14 d of MAOIs; ↓ effects W/ antacids; ↑ effects OF β-adrenergic bronchodilators, dopamine, dobutamine, theophylline Labs: ↑ ANA titers, BUN, K+, serum glucose, LFTs, triglycerides, uric acid; monitor QT interval NIPE: N D/C abruptly after long-term use; take w/o food; administer antacids 2hr < or > sotalol; Betapace should not be substituted for Betapace AF because of differences in labeling Spironolactone (Aldactone) [Potassium Sparing Diuretic] Uses: *Hyperaldosteronism, ascites from CHF or cirrhosis* Action: Aldosterone antagonist; K+-sparing diuretic Dose: Adults. 25–100 mg PO qid; CHF (NYHA class III–IV) 25–50 mg/d. Peds. 1–3.3 mg/kg/24 h PO ÷ bid–qid. Neonates: 0.5–1 mg/kg/dose q8h; w/ food Caution: [D, +] Contra: ↑ K+, renal failure, anuria Disp: Tabs 25, 50, 100 mg SE: ↑ K+ & gynecomastia, arrhythmia, sexual dysfunction, confusion, dizziness, D/N/V, abnormal menstruation Interactions: ↑ Risk of hyperkalemia W/ ACEIs, K supls, K+-sparing diuretics, ↑ K diet; ↑ effects OF Li; ↓ effects W/ salicylates; ↓ effects OF anticoagulants Labs:↑ K+ BUN NIPE: Take w/ food; ↑ risk of gynecomastia; maximum effects of drug may take 2–3 wk Stavudine (Zerit) [Antiretroviral/Reverse Transcriptase In- hibitor] WARNING: Lactic acidosis & severe hepatomegaly w/ steatosis & pancreatitis reported Uses: *Advanced HIV* Action: Reverse transcriptase inhibitor Dose: Adults. >60 kg: 40 mg bid. <60 kg: 30 mg bid. Peds. Birth–13 d: 0.5 mg/kg q12h. >14 d & <30 kg: 1 mg/kg q12h. =30 kg: Adult dose; ↓ in renal insuff failure Caution: [C, +] Contra: Allergy Disp: Caps 15, 20, 30, 40 mg; soln 1 mg/mL SE: Peripheral neuropathy, HA, chills, fever, malaise, rash, GI upset, anemias, lactic acidosis, pancreatitis Interactions: ↑ Risk of pancreatitis W/ didanosine; 260 Steroids, Systemic

↑ effects W/ probenecid; ↓ effects W/ zidovudine Labs: ↑ LFTs NIPE: Take W/O regard to food; take W/ plenty of H2O Steroids, Systemic [Glucocorticoid] (See Also Table 3 ) The following relates only to the commonly used systemic glucocorticoids Uses: *Endocrine disorders* (adrenal insuff), *rheumatoid disorders, collagen–vascular Dzs, derm Dzs, allergic states, cerebral edema*, nephritis, nephrotic synd, immunosuppression for transplantation, ↑ Ca2+, malignancies (breast, lymphomas), preop (in any pt who has been on steroids in the previous year, known hypoadrenalism, preop for adrenalectomy); inj into joints/tissue Action: Glucocorticoid Dose: Varies w/ use & institutional protocols • Adrenal insuff, acute: Adults. Hydrocortisone: 100 mg IV; then 300 mg/d ÷ q6h; convert to 50 mg PO q8h × 6 doses, taper to 30–50 mg/d ÷ bid. Peds. Hydrocor- tisone: 1–2 mg/kg IV, then 150–250 mg/d ÷ tid. • Adrenal insuff, chronic (physiologic replacement): May need mineralocorticoid supl such as Florinef. Adults. Hydrocortisone 20 mg PO qAM, 10 mg PO qPM; cortisone 0.5–0.75 mg/kg/d ÷ bid; cortisone 0.25–0.35 mg/kg/d IM; dexamethasone 0.03–0.15 mg/kg/d or 0.6–0.75 mg/m2/d ÷ q6–12h PO, IM, IV. Peds. Hy- drocortisone: 0.5–0.75 mg/kg/d PO tid; hydrocortisone succinate 0.25–0.35 mg/kg/d IM. • Asthma, acute: Adults. Methylprednisolone: 60 mg PO/IV q6h or dexamethasone 12 mg IV q6h. Peds. Prednisolone: 1–2 mg/kg/d or prednisone 1–2 mg/kg/d ÷ daily–bid for up to 5 d; Methylprednisolone: 2–4 mg/kg/d IV ÷ tid; Dexam- ethasone: 0.1–0.3 mg/kg/d ÷ q6h. • Congenital adrenal hyperplasia: Peds. Initial hydrocortisone 30–36 mg/m2/d PO ÷ 1/3 dose qAM, 2/3 dose qPM; maint 20–25 mg/m2/d ÷ bid. • Extubation/airway edema: Adults. Dexamethasone: 0.5–1 mg/kg/d IM/IV ÷ q6h (start 24 h prior to extubation; continue × 4 more doses). Peds. Dexamethasone: 0.1–0.3 mg/kg/d ÷ q6h × 3 3–5 d (start 48–72 h before extubation). • Immunosuppressive/anti-inflammatory: Adults & Older Peds. Hydrocorti- sone: 15–240 mg PO, IM, IV q12h; Methylprednisolone: 4–48 mg/d PO, taper to lowest effective dose; Methylprednisolone Na succinate: 10–80 mg/d IM. Adults. Prednisone or prednisolone: 5–60 mg/d PO ÷ daily–qid. Infants & Younger Children. Hydrocortisone: 2.5–10 mg/kg/d PO ÷ q6–8h; 1–5 mg/kg/d IM/IV ÷ bid. • Nephrotic synd: Peds. Prednisolone or prednisone: 2 mg/kg/d PO tid–qid until urine is protein-free for 5 d, use up to 28 d; for persistent proteinuria, 4 mg/kg/dose PO qod max 120 mg/d for an additional 28 d; maint 2 mg/kg/dose qod for 28 d; taper over 4–6 wk (max 80 mg/d). • Septic shock (controversial): Adults. Hydrocortisone: 500 mg–1 g IM/IV q2–6h. Peds. Hydrocortisone: 50 mg/kg IM/IV, repeat q4–24 h PRN. • Status asthmaticus: Adults & Peds. Hydrocortisone: 1–2 mg/kg/dose IV q6h; then ↓ by 0.5–1 mg/kg q6h. Streptomycin 261

• Rheumatic Dz: Adults. Intra-articular: Hydrocortisone acetate: 25–37.5 mg large joint, 10–25 mg small joint; methylprednisolone acetate 20–80 mg large joint, 4–10 mg small joint. Intrabursal: Hydrocortisone acetate: 25–37.5 mg. Intraganglial: Hydrocortisone acetate: 25–37.5 mg. Tendon sheath: Hydrocorti- sone acetate: 5–12.5 mg. • Periop steroid coverage: Hydrocortisone 100 mg IV night before surgery, 1 h preop, intraop, & 4, 8, 12 h postop; postop day 1 100 mg IV q6h; postop day 2 100 mg IV q8h; postop day 3 100 mg IV q12h; postop day 4 50 mg IV q12h; postop day 5 25 mg IV q12h; resume prior PO dosing if chronic use or D/C if only periop coverage required. • Cerebral edema: Dexamethasone: 10 mg IV; then 4 mg IV q4–6h. Caution: [C, ?/–] Contra: Active varicella Infxn, serious Infxn except TB, fungal Infxns Disp: Table 3 SE: ↑ appetite, hyperglycemia, ↓ K+, osteoporosis, nervousness, insomnia, “steroid psychosis,” adrenal suppression NIPE: Never abruptly D/C steroids, especially in chronic Rx; taper dose; hydrocortisone succinate for systemic, acetate for intra-articular Streptokinase (Streptase, Kabikinase) [Plasminogen Acti- vator/Thrombolytic Enzyme] Uses: *Coronary artery thrombosis, acute massive PE, DVT, & some occluded vascular grafts* Action: Activates plasminogen to plasmin that degrades fibrin Dose: Adults. PE: Load 250,000 units peripheral IV over 30 min, then 100,000 units/h IV for 24–72 h. Coronary artery thrombosis: 1.5 million units IV over 60 min. DVT or arterial embolism: Load as w/ PE, then 100,000 units/h for 72 h; 1.5 million IU in a 1 h inf (ECC 2005) Peds. 3500–4000 units/kg over 30 min, then 1000–1500 units/kg/h. Occluded catheter (controversial): 10,000–25,000 units in NS to final volume of catheter (leave in for 1 h, aspirate & flush w/ NS) Caution: [C, +] Contra: Streptococcal Infxn or streptokinase in last 6 mo, active bleeding, CVA, TIA, spinal surgery/trauma in last month, vascular anomalies, severe hepatic/renal Dz, endocarditis, pericarditis, severe uncontrolled HTN Disp: Powder for inj 250,000, 750,000, 1,500,000 units SE: Bleeding, ↓ BP, fever, bruising, rash, GI upset, hemorrhage, anaphylaxis Interac- tions: ↑ Risk of bleeding W/ anticoagulants, ASA, heparin, indomethacin, NSAIDs, dong quai, feverfew, garlic, ginger, horse chestnut, red clover Labs: ↑ PT, PTT NIPE: If inf inadequate to keep clotting time 2–5× control, see package for adjustments; antibodies remain 3–6 mo following dose Streptomycin [Antibiotic/Aminoglycoside] WARNING: Neuro/ oto/renal tox possible; neuromuscular blockage w/resp paralysis possible Uses: *TB*, streptococcal or enterococcal endocarditis Action: Aminoglycoside; ↓ protein synth Dose: Adults. Endocarditis: 1 g q12h 1–2 wk, then 500 mg q12h 1–4 wk; TB: 15 mg/kg/d (up to 1 g), directly observed therapy (DOT) 2 × wk 20–30 mg/kg/dose (max 1.5 g), DOT 3 × wk 25–30 mg/kg/dose (max 1 g). Peds. 15 mg/kg/d; DOT 2 × wk 20–40 mg/kg/dose (max 1 g); DOT 3 × wk 25–30 mg/kg/dose (max 1 g); ↓ w/in renal failure insuff, either IM or IV over 30–60 min 262 Streptozocin

Caution: [D, +] Contra: PRG Disp: Inj 400 mg/mL (1-g vial) SE: ↑ Incidence of vestibular & auditory tox, ↑ neurotox risk in pts w/ impaired renal function Notes: Monitor levels: Peak 20–30 μg/mL, Trough <5 μg/mL; Toxic peak > 50, Trough > 10; IV over 30–60 min Interactions: ↑ Risk of nephrotox W/ amphotericin B, cephalosporins, cisplatin, methoxyflurane, polymyxin B, vancomycin; ↑ risk of ototox W/ carboplatin, furosemide, mannitol, urea; ↑ effects OF anticoagulants Labs: False + urine glucose, false ↑ urine protein NIPE: ↑ Fluid intake Streptozocin (Zanosar) [Alkylating Agent/Nitrosourea] Uses: *Pancreatic islet cell tumors* & carcinoid tumors Action: DNA–DNA (inter- strand) cross-linking; DNA, RNA, & protein synth inhibitor Dose: Per protocol; ↓ in renal failure Caution: w/ renal failure [D, ?/–] Contra: w/ rotavirus vaccine, PRG Disp: Inj 1 g SE: N/V/D, duodenal ulcers, depression, ↓ BM rare (20%) & mild; nephrotox (proteinuria & azotemia dose related), hypophosphatemia dose limiting; hypo-/hyperglycemia; inj site Rxns Interactions: ↑ Risk of nephrotox W/ aminoglycosides, amphotericin B, cisplatin, vancomycin; ↑ effects OF doxorubicin; ↓ effects W/ phenytoin Labs: Monitor Cr NIPE: N PRG, breast-feeding; ↑ fluid intake to 2–3 L/d Succimer (Chemet) [Chelating Agent] Uses: *Lead poisoning (levels >45 μg/mL)* Action: Heavy-metal chelating agent Dose: Adults & Peds. 10 mg/kg/dose q8h × 5 d, then 10 mg/kg/dose q12h for 14 d; ↓ in renal impair Caution: [C, ?] Contra: Allergy Disp: Caps 100 mg SE: Rash, fever, GI upset, hemorrhoids, metallic taste, drowsiness, ↑ LFTs Labs: ↑ LFTs; monitor lead levels NIPE: N Take W/ other chelating agents; ↑ fluid intake to 2–3 L/d may open capsules Succinylcholine (Anectine, Quelicin, Sucostrin, others) [Skeletal Muscle Relaxant] WARNING: Risk of cardiac arrest from hyperkalemic rhabdomyolysis Uses: *Adjunct to general anesthesia, facilitates ET intubation; induce skeletal muscle relaxation during surgery or mechanical ventilation* Action: Depolarizing neuromuscular blocker; rapid onset, short duration (3–5 min) Dose: Adults. Rapid sequence intubation 1–2 mg/kg IV over 10–30 s or 2–4 mg/kg IM (ECC 2005) Peds. 1–2 mg/kg/dose IV, then by 0.3–0.6 mg/kg/dose q5min use of CI not OK; ↓ w/ severe renal/hepatic impair Caution: See Warning [C, M] Con- tra: w/ malignant hyperthermia risk, myopathy, recent major burn, multiple trauma, extensive skeletal muscle denervation, NAG, pseudocholinesterase deficiency Disp: Inj 20, 50, 100 mg/mL SE: Fasciculations, ↑ intraocular, intragastric, intracranial pressure, salivation, myoglobinuria, malignant hyperthermia, resp depression, or prolonged apnea; multiple drugs potentiate; CV effects (arrhythmias, ↓ BP, brady/tachycardia) Interactions: ↑ Effects W/ amikacin, gentamicin, neomycin, streptomycin, Li, MAOIs, opiates; ↓ effect W/ diazepam Labs: ↑ Serum K+ NIPE: May be given IVP/inf/IM deltoid; hyperkalemic rhabdomyolysis in children with undiagnosed myopathy such as Duchenne muscular dystrophy Sulfasalazine 263

Sucralfate (Carafate) [Antiulcer Agent/Pepsin Inhibitor] Uses: *Duodenal ulcers*, gastric ulcers, stomatitis, GERD, preventing stress ulcers, esophagitis Action: Forms ulcer-adherent complex that protects against acid, pepsin, & bile acid Dose: Adults. 1 g PO qid, 1 h prior to meals & hs. Peds. 40–80 mg/kg/d ÷ q6h; continue 4–8 wk unless healing demonstrated by x-ray or endoscopy; separate from other drugs by 2 h; on empty stomach ac Caution: [B, +] Contra: Component allergy Disp: Tabs 1 g; susp 1 g/10 mL SE: Constipation; D, dizziness, xerostomia Interactions: ↓ Effects OF cimetidine, digoxin, levothyroxine, phenytoin, quinolones, quinidine, ranitidine, tetracyclines, theophylline, warfarin NIPE: Take w/o food; Al may accumulate in renal failure Sulfacetamide (Bleph-10, Cetamide, Sodium Sulamyd) [An- tibiotic/Sulfonamide] Uses: *Conjunctival Infxns* Action: Sulfonamide antibiotic Dose: 10% oint apply qid & hs; soln for keratitis apply q2–3h based on severity Caution: [C, M] Contra: Sulfonamide sensitivity; age <2 mo Disp: susp: sulfacetamide 10%/ prednisolone 0.25%, sulfacetamide 10%/ prednisolone 0.5%, sulfacetamide 10%/ prednisolone 0.2% SE: Irritation, burning; blurred vision, brow ache, Stevens–Johnson synd, photosens Interactions: ↓ Effects W/ tetracyclines NIPE: Not compatible W/ Ag-containing preps; purulent exudate inactivates drug; ↑ risk of photosensitivity—use sunscreen Sulfacetamide & Prednisolone (Blephamide, Others) [An- tibiotic, Anti-inflammatory] Uses: *Steroid-responsive inflammatory ocular conditions w/ Infxn or a risk of Infxn* Action: Antibiotic & anti-inflammatory Dose: Adults & Peds >2 y. Apply oint lower conjunctival sac daily–qid; soln 1–3 gtt 2–3 h while awake Caution: [C, ?/–] Sulfonamide sensitivity; age <2 mo Disp: Oint: sulfacetamide/prednisolone (%/%) 10/0.5, 10/0.2, 10/0.25; Susp: sulfacetamide/prednisolone (%/%) 10/0.25, 10/0.5, 10/0.2 SE: Irritation, burning, blurred vision, brow ache, Stevens–Johnson synd, photosens Interactions: ↑ Effects W/ tetracyclines NIPE: Not compatible W/ Ag-containing preps; purulent exudate inactivates drug; ↑ risk OF sensitivity to light; N D/C abruptly; OK ophth susp use as otic agent Sulfasalazine (Azulfidine, Azulfidine EN) [Anti-inflammatory, Antirheumatic (DMARD)/Sulfonamide] Uses: *Ulcerative colitis, RA, juvenile RA*, active Crohn Dz, ankylosing spondylitis, psoriasis Ac- tion: Sulfonamide; actions unclear Dose: Adults. Initial, 1 g PO tid–qid; ↑ to a max of 8 g/d in 3–4 ÷ doses; maint 500 mg PO qid. Peds. Initial, 40–60 mg/kg/24 h PO ÷ q4–6h; maint, 20–30 mg/kg/24 h PO ÷ q6h. RA >6 y: 30–50 mg/kg/d in 2 doses, start w/ 1/4–1/3 maint dose, ↑ weekly until dose reached at 1 mo, 2 g/d max; ↓ in renal failure Caution: [B (D if near term), M] Contra: Sulfonamide or salicylate sensitivity, porphyria, GI/GU obst; avoid in hepatic impair Disp: Tabs 500 mg; EC delayed-release tabs 500 mg SE: GI upset; discolors urine; dizziness, HA, photosens, oligospermia, anemias, Stevens–Johnson synd Interactions: ↑ Effects OF oral anticoagulants, oral hypoglycemics, MTX, phenytoin, zidovudine; ↓ effects 264 Sulfinpyrazone

W/ antibiotics; ↓ effects OF digoxin, folic acid, Fe, procaine, proparacaine, sulfonylureas, tetracaine Labs: ↑ LFTs, BUN, Cr; ↓ plts, WBCs NIPE: Take pc; ↑ fluids to 2–3 L/d; ↑ risk of photosensitivity—use sunscreen; skin & urine may become yellow-orange; may stain contact lenses Sulfinpyrazone [Uricosuric/Antigout Agent] Uses: *Acute & chronic gout* Action: ↓ renal tubular absorption of uric acid Dose: 100–200 mg PO bid for 1 wk, ↑ PRN to maint of 200–400 mg bid; max 800 mg/d; take w/ food or antacids, & plenty of fluids; avoid salicylates Caution: [C (D if near term), ?/–] Contra: Renal impair, avoid salicylates; peptic ulcer; blood dyscrasias, near term PRG, allergy Disp: Tabs 100 mg; caps 200 mg SE: N/V, stomach pain, urolithiasis, leukopenia Interactions: ↑ Effects OF oral anticoagulants, oral hypoglycemics, MTX; ↓ effects W/ ASA, cholestyramine, niacin, salicylates, EtOH; ↓ effects OF acetaminophen, theophylline, verapamil Labs: ↑ BUN, Cr; ↓ plts, WBCs NIPE: Take w/ food, ↑ fluids to 2–3 L/d Sulindac (Clinoril) [Analgesic, Anti-inflammatory, Antipyretic/ NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose: 150–200 mg bid, 400 mg/d max; w/ food Caution: [B (D if 3rd tri or near term), ?] Contra: NSAID or ASA sensitivity, w/ ketorolac, ulcer, GI bleeding, postop pain in CABG Disp: Tabs 150, 200 mg SE: Dizziness, rash, GI upset, pruritus, edema, ↓ renal blood flow, renal failure (? fewer renal effects than other NSAIDs), peptic ulcer, GI bleeding Interactions: ↑ Effects W/ NSAIDs, probenecid; ↑ effects OF aminoglycosides, anticoagulants, cyclosporine, digoxin, Li, MTX, K-sparing diuretics; ↑ risk of bleeding W/ ASA, anticoagulants, NSAIDs, thrombolytics, EtOH, dong quai, feverfew, garlic, ginger, horse chestnut, red clover; ↓ effects W/ antacids, ASA; ↓ effects OF antihypertensives, diuretics, hydralazine Labs: ↑ LFTs, BUN, Cr, K+ NIPE: Take w/ food; ↑ risk of photosensitivity—use sunscreen; may take several weeks for full drug effect Sumatriptan (Imitrex) [Antimigraine Agent/Selective 5-HT1 Receptor Agonist] Uses: *Rx acute migraine* Action: Vascular serotonin receptor agonist Dose: Adults. SQ: 6 mg SQ as a single dose PRN; repeat PRN in 1 h to a max of 12 mg/24 h. PO: 25 mg, repeat in 2 h, PRN, 100 mg/d max PO dose; max 300 mg/d. Nasal spray: 1 spray into 1 nostril, repeat in 2 h to 40 mg/24 h max. Peds. Nasal spray: 6–9 y: 5–20 mg/d. 12–17 y: 5–20 mg, up to 40 mg/d Caution: [C, M] Contra: Angina, ischemic heart Dz, uncontrolled HTN, severe hepatic impair, ergot use, MAOI use w/in 14 d Disp: Orally disintegrating tabs 25, 50, 100 mg; Inj 6, 8, 12 mg/mL; orally disintegrating tabs 25, 50, 100 mg, orally disintegrating tabs 25, 50, 100 mg; nasal spray 5, 10, 20 mg/spray SE: Pain & bruising at site; dizziness, hot flashes, paresthesias, CP, weakness, numbness, coronary vasospasm, HTN Interactions: ↑ Effects of weakness, incoordination and hyperreflexia W/ ergots, MAOIs, and SSRIs, horehound, St. John’s Wort Labs: ↑ LFTs NIPE: Admin drug as soon as possible after onset of migraine Tadalafil 265

Sunitinib (Sutent) [Kinase Inhibitor] Uses: *Advanced GI stromal tumor refractory/intolerant of imatinib; advanced RCC* Action: Kinase inhibitor Dose: Adults. 50 mg PO daily × 4 wk, followed by 2 wk holiday = 1 cycle; ↓ to 37.5 mg w/ CYP3A4 inhibitors (Table 11), to ↑ 87.5 mg w/ CYP3A4 inducers Contra: w/ atazanavir Caution: [D, –] Multiple interactions require dose modification (eg, St. John’s Wort) Disp: Caps 12.5, 25, 50 mg SE: ↓ WBC & plt, bleeding, ↑ BP, ↓ ejection fraction, ↑ QT interval, pancreatitis, DVT, Sz, adrenal insuff, N/V/D, skin discoloration, oral ulcers, taste perversion, hypothyroidism LABS: Monitor CBC, plts, chemistries at cycle onset; baseline cardiac Fxn recommended NIPE: ↓ Dose in 12.5-mg increments if not tolerated Tacrine (Cognex) [Anti-Alzheimer Agent/Centrally Acting Reversible Cholinesterase Inhibitor] Uses: *Mild–moderate Alzheimer dementia* Action: Cholinesterase inhibitor Dose: 10–40 mg PO qid to 160 mg/d; separate doses from food Caution: [C, ?] Contra: Previous tacrine-induced jaundice Disp: Caps 10, 20, 30, 40 mg SE: ↑ LFT, HA, dizziness, GI upset, flushing, confusion, ataxia, myalgia, bradycardia Interactions: ↑ Effects W/ cimetidine, quinolones; ↑ effects OF cholinesterase inhibitors, succinylcholine, theophylline; ↓ effects w/ tobacco, food; ↓ effects OF anticholinergics Labs: ↑ LFTs NIPE: If taken w/ food ↓ drug plasma levels by 30%; may take up to 6 wk for ALT elevations—monitor LFTs; serum conc >20 mg/mL have more SE Tacrolimus [FK 506] (Prograf, Protopic) [Immunosuppres- sant/Macrolide] WARNING: ↑ Risk of Infxn and lymphoma Uses: *Pre- vent organ rejection*, eczema Action: Macrolide immunosuppressant Dose: Adults. IV: 0.05–0.1 mg/kg/d cont inf. PO: 0.15–0.3 mg/kg/d ÷ 2 doses. Peds. IV: 0.03–0.05 mg/kg/d as cont inf. PO: 0.15–0.2 mg/kg/d PO ÷ q 12 h. Adults & Peds. Eczema: Apply bid, continue 1 wk after clearing; ↓ in hepatic/renal impair Cau- tion: [C, –] w/ cyclosporine; avoid topical if <2 y of age Contra: Component allergy, castor oil allergy w/ IV form Disp: Caps 0.5, 1, 5 mg; inj 5 mg/mL; oint 0.03, 0.1% SE: Neuro & nephrotox, HTN, edema, HA, insomnia, fever, pruritus, ↓/↑ K+, hyperglycemia, GI upset, anemia, leukocytosis, tremors, paresthesias, pleural effusion, Szs, lymphoma Lab: Monitor levels NIPE: Reports of ↑ CA risk; topical use for short-term & 2nd line Tadalafil (Cialis) [Anti-impotence Agent/PDE5] Uses: *Erectile dysfunction* Action: PDE5 inhibitor, increases cGMP and NO levels; relaxes smooth muscles, dilates cavernosal arteries Dose: Adults. 10 mg PO before sexual activity w/o regard to meals (range 5–20 mg max) 1 dose/72 h; ↓ 5 mg (10 mg max) w/ renal & hepatic insuff Caution: [B, –] w/ CYP3A4 inhibitor (Table 11) Contra: Nitrates, α-blockers (except tamsulosin), severe hepatic impair Disp: 5-, 10-, 20-mg tabs SE: HA, flushing, dyspepsia, rhinitis, back pain, myalgia hearing loss Interactions: ↑ Effects W/ ketoconazole, ritonavir, and other cytochrome P450 CYP3A4 inhibitors; ↑ hypotension W/ antihypertensives, nitrates, EtOH; ↓ effects W/ P450 CYP3A4 inducers such as rifampin, antacids 266 Talc

NIPE: ↑ Risk of priapism; use barrier contraception to prevent STDs; longest acting of class (36 h) Talc (Sterile Talc Powder) [Sclerosing Agent] Uses: *↓ Recur- rence of malignant pleural effusions (pleurodesis)* Action: Sclerosing agent Dose: Mix slurry: 50 mL NS w/ 5-g vial, mix, distribute 25 mL into two 60-mL syringes, volume to 50 mL/syringe w/ NS. Inf each into chest tube, flush w/ 25 mL NS. Keep tube clamped; have pt change positions q15min for 2 h, unclamp tube Cau- tion: [X, –] Contra: Planned further surgery on site Disp: 5 g powder SE: Pain, Infxn NIPE: May add 10–20 mL 1% lidocaine/syringe; must have chest tube placed, monitor closely while tube clamped (tension pneumothorax), not antineoplastic NIPE: Monitor for MI, PE, respiratory distress Tamoxifen [Antineoplastic/Antiestrogen] WARNING: CA of the uterus, stroke, and blood clots can occur Uses: *Breast CA [postmenopausal, estrogen receptor(+)], ↓ reduction of breast CA in high-risk women, met male breast CA*, ductal carcinoma in situ, mastalgia, pancreatic CA, gynecomastia, ovulation induction Action: Nonsteroidal antiestrogen; mixed agonist–antagonist effect Dose: 20–40 mg/d (typically 10 mg bid or 20 mg/d) Prevention: 10 mg PO bid × 5y Caution: [D, –] w/ leukopenia, thrombocytopenia, hyperlipidemia Contra: PRG, undiagnosed vag bleeding, h/o thromboembolism Disp: Tabs 10, 20 mg, oral soln 10 mg/5 mL SE: Uterine malignancy & thrombotic events noted in breast CA prevention trials; menopausal Sxs (hot flashes, N/V) in premenopausal pts; vag bleeding & menstrual irregularities; skin rash, pruritus vulvae, dizziness, HA, peripheral edema; acute flare of bone metastasis pain & ↑ Ca2+; retinopathy reported (high dose) Interactions: ↑ Effects W/ bromocriptine, grapefruit juice; ↑ effects OF cyclosporine, warfarin; ↓ effects W/ antacids, aminoglutethimide, estrogens; Labs: ↑ Ca2+, BUN, Cr, LFTs NIPE: N PRG or breast-feeding; use barrier contraception; ↑ risk of photosensitivity—use sunscreen; ↑ risk of PRG in premenopausal women (induces ovulation); brand Nolvadex suspended in US Tamsulosin (Flomax) [Smooth Muscle Relaxant/Antiadren- ergic] Uses: *BPH* Action: Antagonist of prostatic α-receptors Dose: 0.4 mg/d, may ↑ to 0.8 mg PO daily; Caution: [B, ?] Contra: Female gender Disp: Caps 0.4 mg SE: HA, dizziness, syncope, somnolence, ↓ libido, GI upset, retrograde ejaculation, rhinitis, rash, angioedema, IFIS Interactions: ↑ Effects W/ cimetidine; ↑ hypotension W/ doxazosin, prazosin, terazosin; NIPE: Ensure—test results for prostate CA before drug admin; not for use as antihypertensive; do not open/crush/chew Tazarotene (Tazorac, Avage) [Keratolytic/Retinoid] Uses: *Facial acne vulgaris; stable plaque psoriasis up to 20% BSA* Action: Keratolytic Dose: Adults & Peds >12 y. Acne: Cleanse face, dry, & apply thin film daily hs on acne lesions. Psoriasis: Apply hs Caution: [X, ?/–] Contra: Retinoid sensitivity Disp: Gel 0.05, 0.1%; cream 0.05%, 0.1% SE: Burning, erythema, irritation, rash, photosens, desquamation, bleeding, skin discoloration Interactions: ↑ Risk of Telmisartan 267 photosensitivity W/ quinolones, phenothiazine, sulfonamides, tetracyclines, thiazide diuretics NIPE: N PRG or breast-feeding; use contraception; use sunscreen for ↑ photosensitivity risk; D/C w/ excessive pruritus, burning, skin redness or peeling occur until Sxs resolve Telbivudine (Tyzeka) [Antiretroviral, NRTI] WARNING: May cause lactic acidosis and severe hepatomegaly w/ steatosis when used alone or w/ antiretrovirals; D/C may lead to exacerbations of Hep B; monitor LFTs Uses: *Rx chronic Hep B* Action: Nucleoside RT inhibitor Dose: CrCl >50 mL/min: 600 mg PO daily; CrCl 30–49 mL/min: 600 mg q48 h; CrCl <30 mL/min: 600 mg q72h; ESRD: 600 mg q 96h Caution: [B; ?/–]; may cause myopathy; follow closely w/ other myopathy causing drugs Disp: Tabs 600 mg SE: Fatigue, abd pain, N/V/D, HA, URI, nasopharyngitis, ↑ LFTs/CPK, myalgia, flulike Sxs, dizziness, insomnia, dyspepsia Interactions: ↑ Risk of myopathy W/ azole antifungals, chloroquine, corticosteroids, cyclosporine, erythromycin, fibrates, hydroxychloroquine, niacin, penicillamine, statins, zidovudine; ↑ risk of renal impair W/ cyclosporine, tacrolimus Labs: ↑ LFTs, CPK NIPE: Not a cure for Hep B, does not reduce transmission of Hep B by sexual contact or blood contamination Telithromycin (Ketek) [Antibiotic/Macrolide Derivative] WARNING: May be associated with pseudomembranous colitis and hepatic failure Uses: *Acute bacterial exacerbations of chronic bronchitis, acute bacterial sinusitis; mild–moderate community-acquired pneumonia* Action: Unique macrolide, blocks ↓ protein synth; bactericidal. Spectrum: S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis, C. pneumoniae, M. pneumoniae Dose: Chronic bronchitis/sinusitis: 800 mg (2 tabs) PO daily × 5; Pneumonia: 800 mg (2 tabs) PO daily × 7–10 d Caution: [C, M] Pseudomembranous colitis, ↑ QTc interval, MyG exacerbations, visual disturbances, hepatic dysfunction; dosing in renal impair unknown Contra: Macrolide allergy, use w/ pimozide, w/ MyG Disp: Tabs 300, 400 mg SE: N/V/D, dizziness, blurred vision Interactions: ↑ QTc interval & arrhythmias W/ antiarrhythmics, mesoridazine, quinolone antibiotics, thioridazine; ↑ effects OF alprazolam, atorvastatin, benzodiazepines, CCBs, carbamazepine, cisapride, colchicine, cyclosporine, digoxin, ergot alkaloids, felodipine, lovastatin, mirtazapine, midazolam, nateglinide, nefazodone, pimozide, sildenafil, simvastatin, sirolimus, tacrolimus, tadalafil, triazolam, vardenafil, venlafaxine, verapamil; ↓ effects W/ azole antifungals, ciprofloxin, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, INH, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, verapamil; ↑ effect W/ aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, rifampin, rifamycins Labs: ↑ LFTs, plts NIPE: Take w/o regard to food; N chew/crush tabs; A CYP450 inhibitor Telmisartan (Micardis) [Antihypertensive/ARB] Uses: *HTN, CHF*, DN Action: Angiotensin II receptor antagonist Dose: 40–80 mg/d Cau- tion: [C (1st tri; D 2nd & 3rd tri), ?/–] Contra: Angiotensin II receptor antagonist sensitivity Disp: Tabs 20, 40, 80 mg SE: Edema, GI upset, HA, angioedema, renal 268 Temazepam impair, orthostatic ↓ BP Interactions: ↑ Effects W/ EtOH; ↑ effects OF digoxin; ↓ effects OF warfarin Labs: ↑ Cr, ↓ HMG NIPE: Take w/o regard to food; N PRG; use barrier contraception Temazepam (Restoril) [C-IV] [Sedative/Hypnotic/Benzodi- azepine] Uses: *Insomnia*, anxiety, depression, panic attacks Action: Ben- zodiazepine Dose: 15–30 mg PO hs PRN; ↓ in elderly Caution: [X, ?/–] Potentiates CNS depressive effects of opioids, barbs, EtOH, antihistamines, MAOIs, TCAs Contra: NAG Disp: Caps 7.5, 15, 22.5, 30 mg SE: Confusion, dizziness, drowsiness, hangover Interactions: ↑ Effects W/ cimetidine, disulfiram, kava kava, valerian; ↑ CNS depression W/ anticonvulsants, CNS depressants, EtOH; ↑ effects OF haloperidol, phenytoin; ↓ effects W/ aminophylline, dyphylline, OCPs, oxtriphylline, rifampin, theophylline, tobacco; ↓ effects OF levodopa NIPE: Abrupt D/C after >10 d use may cause withdrawal; N use in PRG or breast-feeding Temsirolimus (Torisel Kit) [mTOR Inhibitor] Uses: *Advanced RCC* Action: mTOR inhibitor Dose: 25 mg IV over 30–60 min × 1 week; continue until tox or progression; pre med w/ 25–50 mg Benadryl 30 min before Cau- tion: [D, –] w/ CYP3A4 inhib/inducers (Table 11), avoid grapefruit juice, vaccines, immed postop Contra: None Disp: 25 mg/mL w/ diluent SE: Hypersen- sitivity Rxn, rash, asthenia, mucositis, N, edema, anorexia, poor wound healing, bowel perf Labs: ↑ Glucose/lipids/ALP/AST/Cr; ↓ Hct, WBC, plt; monitor Cr, CBC; hold w/ ANC <1000mm3 or plt <75,000/mm3 NIPE: Combine only w/ provided diluent for IV admin Tenecteplase (TNKase) [Thrombolytic/Recombinant Tissue Plasminogen Activator] Uses: *Restore perfusion & ↓ mortality w/ AMI* Action: Thrombolytic; TPA Dose: 30–50 mg; see table below

Tenecteplase Dosing

Weight TNKase TNKasea Volume (kg) (mg) (mL)

<60 30 6 ≥60–70 35 7 ≥70–80 40 8 ≥80–90 45 9 ≥90 50 10

aFrom one vial of reconstituted TNKase. Terazosin 269

Caution: [C, ?], ↑ Bleeding w/ NSAIDs, ticlopidine, clopidogrel, GPIIb/IIIa antagonists Contra: Bleeding, CVA, major surgery (intracranial, intraspinal) or trauma w/in 2 mo Disp: Inj 50 mg, reconstitute w/ 10 mL sterile H2O SE: Bleed- ing, allergy Interactions: ↑ Risk of bleeding W/ anticoagulants, ASA, clopidogrel, dipyridamole, indomethacin, vitamin K antagonists; ↓ effects W/ aminocaproic acid Labs: ↑ PT, PTT, INR NIPE: Eval for S/Sxs bleeding; do not shake w/ recons; do not use w/ D5W Tenofovir (Viread) [Antiretroviral/NRTI] WARNING: Lactic acidosis & severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combo w/ other antiretrovirals. Not OK w/ chronic hepatitis; effects in patients co-infected with Hep B & HIV unknown Uses: *HIV Infxn* Action: Nucleotide RT inhibitor Dose: 300 mg PO daily ? to w/ or w/o meal; CrCl ? = 50 mL/min ? q24h, CrCl 30–49 mL/min q48h, CrCl 10–29 mL/min 2 × week Caution: [B, ?/–] Didanosine (separate admin times), lopinavir, ritonavir w/ known risk factors for liver Dz Con- tra: Hypersensitivity Disp: Tabs 300 mg SE: GI upset, metabolic synd, hepatotox; separate didanosine doses by 2 h Interactions: ↑ Effects W/ acyclovir, cidofovir, ganciclovir, indinavir, lopinavir, ritonavir, valacyclovir, food Labs: ↑ LFTs, triglycerides NIPE: Take w/ food, take 2 h before or 1 h after didanosine, lopinavir/ritonavir; combo product w/ emtricitabine is Truvada Tenofovir/Emtricitabine (Truvada) [Antiretroviral, Dual NRTI] WARNING: Lactic acidosis & severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combo w/ other antiretrovirals. Not OK w/ chronic hepatitis; effects in patients co- infected with Hep B & HIV unknown Uses: *HIV Infxn* Action: Dual nucleotide RT inhibitor Dose: 300 mg PO daily w/ or w/o a meal adjust w/ renal impairment Caution: w/ known risk factors for liver Dz [B, ?/–] Contra: CrCl <30 mL/min; Disp: Tabs: 200 mg emtricitabine/300 mg tenofovir SE: GI upset, rash, metabolic synd, hepatotox Interactions: ↑ Effects W/ acyclovir, cidofovir, ganciclovir, indinavir, lopinavir, ritonavir, valacyclovir, food; ↓ effects OF didanosine, lamivudine, ritonavir Labs: ↑ LFTs, triglycerides NIPE: Take w/ food, take 2 h before or 1 h after didanosine, lopinavir/ritonavir; causes redistribution and accumulation of body fat; take w/ other antiretrovirals; not a cure for HIV or prevention of opportunistic Infxns Terazosin (Hytrin) [Antihypertensive/Peripherally Acting α Antiadrenergic] Uses: *BPH & HTN* Action: 1-Blocker (blood vessel & bladder neck/prostate) Dose: Initial, 1 mg PO hs; ↑ 20 mg/d max Caution: [C, ?] w/ BB, CCB, ACEI Contra: α-Antagonist sensitivity Disp: Tabs 1, 2, 5, 10 mg; caps 1, 2, 5, 10 mg SE: ↓ BP, & syncope following 1st dose; dizziness, weakness, nasal congestion, peripheral edema, palpitations, GI upset Interactions: ↑ Effects W/ antihypertensives, diuretics; ↑ effects OF finasteride; ↓ effects W/ NSAIDs, α-blockers, ephedra, garlic, ginseng, saw palmetto, yohimbe; ↓ effects 270 Terbinafine

OF clonidine Labs: ↓ Albumin, HMG, Hct, WBCs NIPE: Take w/o regard to food, N D/C abruptly; caution w/ 1st dose syncope; if for HTN, combine w/ thiazide diuretic Terbinafine (Lamisil) [Antifungal] Uses: *Onychomycosis, athlete’s foot, jock itch, ringworm*, cutaneous candidiasis, pityriasis versicolor Action: ↓ squalene epoxidase resulting in fungal death Dose: PO: 250 mg/d PO for 6–12 wk. Topical: Apply to area; ↓ in renal/hepatic impair Caution: [B, –] ↑ Effects of drug metab by CYP2D6, liver Dz, renal impairment (CrCl <60) Disp: Tabs 250 mg; cream, gel, soln 1% SE: HA, dizziness, rash, pruritus, alopecia, GI upset, taste perversion, neutropenia, retinal damage, Stevens–Johnson synd Interactions: ↑ Ef- fects W/ cimetidine; ↑ effects OF dextromethorphan, theophylline, caffeine; ↓ effects W/ rifampin; ↓ effects OF cyclosporine Labs: LFT abnormalities NIPE: Effect may take months due to need for new nail growth; do not use occlusive dressings Terbutaline (Brethine) [Bronchodilator/Sympathomimetic] Uses: *Reversible bronchospasm (asthma, COPD); inhibit labor* Action: Sympa- thomimetic; tocolytic Dose: Adults. Bronchodilator: 2.5–5 mg PO qid or 0.25 mg SQ; repeat in 15 min PRN ;max 0.5 mg in 4 h; Met-dose inhaler: 2 inhal q4–6h. Premature labor: Acutely 2.5–10 mg/min/IV, gradually ↑ as tolerated q10–20 min; maint 2.5–5 mg PO q4–6h until term Peds. PO: 0.05–0.15 mg/kg/dose PO tid; max 5 mg/24h; ↓ in renal failure Caution: [B, +] ↑ tox w/ MAOIs, TCAs; DM, HTN, hyperthyroidism, CV disease, convulsive disorders, ↓ K+ Contra: Component allergy Disp: Tabs 2.5, 5 mg; inj 1 mg/mL; met-dose inhaler SE: HTN, hyperthy- β roidism, 1-adrenergic effects w/ high dose, nervousness, trembling, tachycardia, HTN, dizziness Interactions: ↑ Effects W/ MAOIs, TCAs; ↓ effects W/ BBs Labs: ↑ LFTs, serum glucose NIPE: Take oral dose w/ food Terconazole (Terazol 7) [Antifungal] Uses: *Vaginal fungal Infxns* Action: Topical triazole antifungal Dose: 1 applicatorful or 1 supp intravag hs × 3–7 d Caution: [C, ?] Contra: Component allergy Disp: Vag cream 0.4, 0.8%, vag supp 80 mg SE: Vulvar/vag burning NIPE: Insert cream or supp high into vag, complete full course of Rx, N intercourse during drug Rx, ↑ risk of breakdown of latex condoms & diaphragms w/drug Teriparatide (Forteo) [Antiosteoporotic/Parathyroid Hor- mone] WARNING: ↑ Osteosarcoma risk in animals, therefore only use in pts for whom the potential benefits outweigh risks Uses: *Severe/refractory osteoporosis* Action: PTH (recombinant) Dose: 20 μg SQ daily in thigh or abdomen Cau- tion: [C, ?/–] Contra: w/ Paget Dz, prior radiation, bone metastases, ↑ Ca2+; caution in urolithiasis Disp: 3-mL prefilled device (discard after 28 d) SE: Ortho- static ↓ BP on administration, N/D, ↑ Ca, leg cramps Labs: ↑ Serum Ca2+, uric acid, urine Ca2+ NIPE: N Take if h/o Paget Dz, bone mets or malignancy, or h/o radiation therapy; take w/o regard to food; not used to prevent osteoporosis; 2 y max use; osteosarcoma in animals Tetracycline 271

Testosterone (AndroGel, Androderm, Striant, Testim) [CIII] [Androgen Replacement] Uses: *Male hypogonadism* Action: Testos- terone replacement; ↑ lean body mass, libido Dose: All daily AndroGel: 5 g gel. Androderm: Two 2.5-mg or one 5-mg patch daily. Striant: 30-mg buccal tabs bid. Testim: One 5-g gel tube. Caution: [N/A, N/A] Contra: PCa, male breast CA Disp: AndroGel, Testim: 5-g gel (50-mg test); Androderm: 2.5-, 5-mg patches; Stri- ant: 30-mg buccal tabs SE: Site Rxns, acne, edema, wt gain, gynecomastia, HTN, ↑ sleep apnea, prostate enlargement Interactions: ↑ Effects OF anticoagulants, cyclosporine, insulin, hypoglycemics, oxyphenbutazone; ↑ effects W/ grapefruit juice; ↓ effects W/ St. John’s Wort Labs: ↑ AST, Cr, Hgb, Hct, LDL, serum alkaline phosphatase, bilirubin, Ca, K, & Na; ↓ thyroid hormones NIPE: Wear gloves if handling transdermal patches; topical drug may cause virilization in female partners. Apply Testoderm to dry shaved scrotal skin (N use chemical depilatories), Androderm to nonscrotal skin, AndroGel to shoulder and upper arms, buccal system, on gum above incisors NIPE: Injectable testosterone enanthate (Delatestryl; Testro-L.A.) & cypionate (Depo-Testosterone) require inj every 14–28 d with highly variable serum levels; PO agents (methyltestosterone & oxandrolone) associated w/ hepatitis/ hepatic tumors; transdermal/mucosal forms preferred Tetanus Immune Globulin [Tetanus Prophylaxis/Immune Serum] Uses: *Passive tetanus immunization* (suspected contaminated wound w/ unknown immunization status, see also Table 8) Action: Passive immunization Dose: Adults & Peds. 250–500 units IM (higher dose w/ delayed Rx) Caution: [C, ?] Contra: Thimerosal sensitivity Disp: Inj 250-unit vial/syringe SE: Pain, tenderness, erythema at site; fever, angioedema, muscle stiffness, anaphylaxis Interactions: ↓ Immune response when admin W/ Td NIPE: Drug does not cause AIDS or hepatitis; may begin active immunization series at different inj site if required Tetanus Toxoid [Tetanus Prophylaxis/Vaccine] Uses: *Tetanus prophylaxis* Action: Active immunization Dose: Based on previous immunization, Table 8 Caution: [C, ?] Contra: Chloramphenicol use, neurologic Sxs w/ previous use, active Infxn w/ routine primary immunization Disp: Inj tetanus toxoid, fluid, 4–5 Lf units/0.5 mL; tetanus toxoid, adsorbed, 5, 10 Lf units/0.5 mL SE: Local erythema, induration, sterile abscess, chills, fever, neurologic disturbances Interactions: Delay of active immunity if given W/ tetanus immune globulin; ↓ immune response if given to pts taking corticosteroids or immunosuppressive drugs NIPE: Stress the need of timely completion of immunization series Tetracycline (Achromycin V, Sumycin) [Antibiotic/Tetracy- cline] Uses: *Broad-spectrum antibiotic* Action: Bacteriostatic; ↓ protein synth. Spectrum: Gram(+): Staphylococcus sp, Streptococcus sp; Gram(–): H. pylori; Atypicals: Chlamydia sp, Rickettsia sp, & Mycoplasma sp Dose: Adults. 250–500 mg PO bid–qid. Peds > 8 y. 25–50 mg/kg/24 h PO q6–12h; ↓ w/ 272 Thalidomide renal/hepatic impair, w/o food preferred Caution: [D, +] Contra: PRG, antacids, w/ dairy products, children =8 y Disp: Caps 100, 250, 500 mg; tabs 250, 500 mg; PO susp 250 mg/5 mL SE: Photosens, GI upset, renal failure, pseudotumor cerebri, hepatic impair Interactions: ↑ Effects OF anticoagulants, digoxin; ↓ effects W/ antacids, cimetidine, laxatives, penicillin, Fe supl, dairy products; ↓ effects OF OCPs Labs: False - of urinary glucose, serum folate; false ↑ serum glucose NIPE: N Take w/ dairy products; take w/o food; use barrier contraception; can stain tooth enamel & depress bone formation in children Thalidomide (Thalomid) [Immunomodulatory Agent] WARNING: Restricted use; use associated w/ severe birth defects and ↑ risk of venous thromboembolism Uses: *Erythema nodosum leprosum (ENL)*, GVHD, aphthous ulceration in HIV(+) Action: ↓ Neutrophil chemotaxis, ↓ monocyte phagocytosis Dose: GVHD: 100–1600 mg PO daily. Stomatitis: 200 mg bid for 5 d, then 200 mg daily up to 8 wk. ENL: 100–300 mg PO qhs Cautions: [X, –] May ↑ HIV viral load; h/o Szs Contra: PRG; sexually active males not using latex condoms, or females not using 2 forms of contraception Disp: 50, 100, 200 mg caps SE: Dizziness, drowsiness, rash, fever, orthostasis, Stevens–Johnson synd, peripheral neuropathy, Szs Interactions: ↑ Effects OF barbiturates, CNS depressants, chlorpromazine, reserpine, EtOH; ↑ peripheral neuropathy W/ INH, Li, metronidazole, phenytoin Labs: Monitor LFTs, WBC, differential, PRG test before start of therapy & monthly during therapy NIPE: If also taking drugs that ↓ hormonal contraceptives (carbamazepine, griseofulvin, phenytoin, rifabutin, rifampin) use two other contraceptive methods; take 1 h pc—food will affect absorption; photosensitivity—use sunscreen; N PRG & breast-feeding; health care provider must register w/ STEPS risk management program; informed consent necessary; immediately D/C if rash develops Theophylline (Theo24, TheoChron) [Bronchodilator/Xan- thine Derivative] Uses: *Asthma, bronchospasm* Action: Relaxes smooth muscle of the bronchi & pulm blood vessels Dose: Adults. 900 mg PO ÷ q6h; SR products may be ÷ q8–12h (maint). Peds. 16–22 mg/kg/24 h PO ÷ q6h; SR products may be ÷ q8–12h (maint); ↓ in hepatic failure Caution: [C, +] Multiple interactions (eg, caffeine, smoking, carbamazepine, barbiturates, β-blockers, ciprofloxacin, E-mycin, INH, loop diuretics) Contra: Arrhythmia, hyperthyroidism, uncontrolled Szs Disp: Elixir 80, 15 mL; soln 80 mg/15 mL; syrup 80, 150 mg/15 mL; caps 100, 200, 250 mg; tabs 100, 125, 200, 250, 300 mg; SR caps 100, 125, 200, 250, 260, 300 mg; SR tabs 100, 200, 300, 400, 450, 600 mg SE: N/V, tachycardia, Szs, nervousness, arrhythmias Notes: Levels IV: Sample 12–24 h after inf started; Therapeutic: 5–15 μg/mL; Toxic: >20 μg/mL; 1/2 life: Non- smoking adults 8 h/children and smoking adults 4 h; Levels PO: Trough just before next dose; Therapeutic: 5–15 μg/mL Interactions: ↑ Effects W/ allopurinol, BBs, CCBs, cimetidine, corticosteroids, macrolide antibiotics, OCPs, quinolones, rifampin, tacrine, tetracyclines, verapamil, zileuton; ↑ effects OF Thioridazine 273 digitalis; ↓ effects W/ barbiturates, loop diuretics, thyroid hormones, tobacco, St John’s Wort; ↓ effects OF benzodiazepines, Li, phenytoin Labs: ↑ Glucose NIPE: Use barrier contraception; take w/ food if GI upset; caffeine foods ↑ drug effects; smoking ↓ drug effects Thiamine [Vitamin B1] [Vitamin] Uses: *Thiamine deficiency (beriberi), alcoholic neuritis, Wernicke encephalopathy* Action: Dietary supl Dose: Adults. Deficiency: 100 mg/d IM for 2 wk, then 5–10 mg/d PO for 1 mo. Wernicke encephalopathy: 100 mg IV single dose, then 100 mg/d IM for 2 wk. Peds. 10–25 mg/d IM for 2 wk, then 5–10 mg/24 h PO for 1 mo Caution: [A (C if doses exceed RDA), +] Contra: Component allergy Disp: Tabs 5, 10, 25, 50, 100, 250, 500 mg; inj 100, 200 mg/mL SE: Angioedema, paresthesias, rash, anaphylaxis w/ rapid IV Interactions: ↑ Effects OF neuromuscular blocking drugs Labs: Interference w/ theophylline levels NIPE: Give IV slowly; IV use associated w/ anaphylactic Rxn Thiethylperazine (Torecan) [Antiemetic] Uses: *N/V* Action: An- tidopaminergic antiemetic Dose: 10 mg PO, PR, or IM daily–tid; ↓ in hepatic failure Caution: [X, ?] Contra: Phenothiazine & sulfite sensitivity, PRG Disp: Tabs 10 mg; supp 10 mg; inj 5 mg/mL SE: EPS, xerostomia, drowsiness, orthostatic ↓ BP, tachycardia, confusion Interactions: ↑ Effects W/ atropine, CNS depressants, epinephrine, Li, MAOIs, TCAs, EtOH; ↑ effects OF antihypertensives, phenytoin; ↓ effects OF bromocriptine, cabergoline, levodopa Labs: ↑ Serum prolactin level, interferes w/ PRG test NIPE: May cause tardive dyskinesia; ↑ risk of photosensitivity—use sunscreen 6-Thioguanine [6-TG] (Tabloid) [Purine Antimetabolite] Uses: *AML, ALL, CML* Action: Purine-based antimetabolite (substitutes for natural purines inter- fering w/ nucleotide synth) Dose: 2–3 mg/kg/d; ↓ in severe renal/hepatic impair Caution: [D, –] Contra: Resistance to mercaptopurine Disp: Tabs 40 mg SE: ↓ BM (leucopenia/thrombocytopenia), N/V/D, anorexia, stomatitis, rash, hyperuricemia, rare hepatotox Interactions: ↑ Bleeding W/ anticoagulants, NSAIDs, salicylates, thrombolytics Labs: ↑ Serum and urine uric acid NIPE: Take w/o food; ↑ fluids to 2–3 L/d; N exposure to Infxn Thioridazine (Mellaril) [Antipsychotic/Phenothiazine] WARNING: Dose-related QT prolongation Uses: *Schizophrenia*, psychosis Action: Phenothiazine antipsychotic Dose: Adults. Initial, 50–100 mg PO tid; maint 200–800 mg/24 h PO in 2–4 ÷ doses. Peds >2 y. 0.5–3 mg/kg/24 h PO in 2–3 ÷ doses Caution: [C, ?] Phenothiazine, QTc-prolonging agents, aluminum Contra: Phenothiazine sensitivity Disp: Tabs 10, 15, 25, 50, 100, 150, 200 mg; PO conc 30, 100 mg/mL; SE: Low incidence of EPS; ventricular arrhythmias; ↓ BP, dizziness, drowsiness, neuroleptic malignant synd, Szs, skin discoloration, photosens, constipation, sexual dysfunction, blood dyscrasias, pigmentary retinopathy, hepatic impair Interactions: ↑ Effects W/ BBs; ↑ effects OF anticholinergics, antihypertensives, antihistamines, CNS depressants, nitrates, EtOH; ↓ effects W/ 274 Thiothixene barbiturates, Li, tobacco; ↓ effects OF levodopa Labs: ↑ Serum LFTs; ↓ HMG, Hct, plts, WBC NIPE: ↑ Risk of photosensitivity—use sunscreen, take w/ food; N D/C abruptly; ↓ temp regulation; urine color change to reddish brown; avoid EtOH, dilute PO conc in 2–4 oz Liq Thiothixene (Navane) [Antipsychotic/Thioxanthene] Uses: *Psychotic disorders* Action: Antipsychotic Dose: Adults & Peds > 12 y. Mild–moderate psychosis: 2 mg PO tid, up to 20–30 mg/d. Severe psychosis: 5 mg PO bid; ↑ to max of 60 mg/24 h PRN. IM use: 16–20 mg/24 h ÷ bid–qid; max 30 mg/d. Peds < 12 y. 0.25 mg/kg/24 h PO ÷ q6–12h Caution: [C, ?] Contra: Phe- nothiazine sensitivity Disp: Caps 1, 2, 5, 10, 20 mg; PO conc 5 mg/mL; inj 10 mg/mL SE: Drowsiness, EPS most common; ↓ BP, dizziness, drowsiness, neuroleptic malignant synd, Szs, skin discoloration, photosens, constipation, sexual dysfunction, blood dyscrasias, pigmentary retinopathy, hepatic impair Interac- tions: ↑ Effects W/ BBs; ↑ effects OF anticholinergics, antihistamines, antihypertensives, CNS depressants, nitrates, EtOH; ↓ effects W/ barbiturates, Li, tobacco, caffeine; ↓ effects OF levodopa Labs: ↑ LFTs NIPE: ↑ Risk OF photosensitivity—use sunscreen; take w/ food; N D/C abruptly; ↓ temp regulation; darkens urine color; dilute PO conc immediately before use Tiagabine (Gabitril) [Anticonvulsant] Uses: *Adjunct in partial Szs*, bipolar disorder Action: Inhibition of GABA Dose: Adults & Peds = 12 y. Initial 4 mg/d PO, ↑ by 4 mg during 2nd wk; ↑ PRN by 4–8 mg/d based on response, 56 mg/d max; w/food Caution: [C, M] Contra: Component allergy Disp: Tabs 2, 4, 12, 16 , 20 mg SE: Dizziness, HA, somnolence, memory impair, tremors Interactions: ↑ Effects W/ valproate; ↑ effects OF CNS depressants, EtOH; ↓ effects W/ barbiturates, carbamazepine, phenobarbital, phenytoin, primidone, rifampin, ginkgo biloba NIPE: Take w/ food; N D/C abruptly; used in combo w/ other anticonvulsants Ticarcillin (Ticar) [Antibiotic/Penicillin] Uses: Infxns due to gram(–) bacteria (Klebsiella sp, Proteus sp, E. coli, Enterobacter sp, P. aeruginosa, & Ser- ratia sp) involving the skin, bone, resp & urinary tract, abdomen, sepsis Action: 4th-gen PCN, bactericidal; ↓ cell wall synth. Spectrum: Some gram(+) (Strepto- coccus sp, fair Enterococcus sp, not MRSA), gram(–) enhanced w/ aminoglycoside use; good anaerobes (Bacteroides) Dose: Adults. 3 g IV q4–6h. Peds. 200–300 mg/kg/d IV ÷ q4–6h; ↓ w/in renal insuff failure Caution: [B, +] PCN sensitivity, renal impair, Sz h/o, Na restriction Contra: Allergy to class Disp: Inj 1, 3, 6, 20, 30 g SE: Interstitial nephritis, anaphylaxis, bleeding, rash, hemolytic anemia Interactions: ↑ Effects W/ probenecid; ↑ effects OF anticoagulants, MTX; ↓ effects W/ tetracyclines, ↓ effects OF aminoglycosides Labs: ↑ LFTs NIPE: Moni- tor for S/Sxs super Infxn; frequent loose stools may be due to pseudomembranous colitis; used in combo w/ aminoglycosides Ticarcillin/Potassium Clavulanate (Timentin) [Antibiotic/ Penicillin, Beta-Lactamase Inhibitor] Uses: *Infxns of the skin, Timolol 275 bone, resp & urinary tract, abdomen, sepsis * Action: 4th-gen PCN; bactericidal; ↓ cell wall synth; clavulanic acid blocks β-lactamase. Spectrum: Good gram(+), not MRSA; good gram(–) & anaerobes Dose: Adults. 3.1 g IV q4–6h. Peds. 200–300 mg/kg/d IV ÷ q4–6h; ↓ in renal failure Caution: [B, +/–] PCN sensitivity Disp: Inj 3g/1g vial SE: Hemolytic anemia, false + proteinuria; Inter- actions: ↑ Effects W/ probenecid; ↑ effects OF anticoagulants, MRX; ↓ effects W/ tetracyclines, ↓ effects OF aminoglycosides, OCPs Labs: False ↑ urine glucose, false + urine proteins NIPE: Monitor for S/Sxs super Infxn; frequent loose stools may be due to pseudomembranous colitis; use barrier contraception; often used in combo w/ aminoglycosides; penetrates CNS with meningeal irritation; see also ticarcillin Ticlopidine (Ticlid) [Antiplatelet/Platelet Aggregation In- hibitor] WARNING: Neutropenia/agranulocytosis, TTP, aplastic anemia reported Uses: *↓ Risk of thrombotic stroke*, protect grafts status post CABG, diabetic microangiopathy, ischemic heart Dz, DVT prophylaxis, graft prophylaxis after renal transplant Action: Plt aggregation inhibitor Dose: 250 mg PO bid w/ food Caution: [B, ?/–], ↑ tox of ASA, anticoagulation, NSAIDs, theophylline Contra: Bleeding, hepatic impair, neutropenia, thrombocytopenia Disp: Tabs 250 mg SE: Bleeding, GI upset, rash Interactions: ↑ Effects W/ anticoagulants, cimetidine, dong quai, evening primrose oil, feverfew, garlic, ginkgo biloba, ginseng, red clover; ↑ effects OF ASA, phenytoin, theophylline; ↓ effects W/ antacids; ↓ effects OF cyclosporine, digoxin Labs: ↑ LFTs; ↓ plts, RBCs, WBCs; monitor CBC for 1st 3 mo NIPE: Take w/food Tigecycline (Tygacil) [Antibiotic/Related to Tetracycline] Uses: *Rx complicated skin & soft tissue Infxns, & complicated intra-abd Infxns* Action: New class: related to tetracycline; Spectrum: Broad gram(+), gram(–), anaerobic, some mycobacterial; E. coli, E. faecalis (vanco-susceptible isolates), S. aureus (meth-susceptible/resistant), Streptococcus (agalactiae, anginosus grp, pyogenes), C. freundii, E. cloacae, B. fragilis group, C. perfringens, Peptostreptococcus sp Dose: Adults. 100 mg, then 50 mg q12h IV over 30–60 min every 12 h Caution: [D, ?] hepatic impair, monotherapy w/ intestinal perf, not OK in peds Contra: Com- ponent sensitivity Disp: Inj 50 mg vial SE: N/V, inj site Rxn Interactions: ↑ Risk of bleeding W/ warfarin; ↓ effectiveness OF hormonal contraceptives Labs: ↑ LFTs, BUN, Cr, PT, PTT, INR; ↓ K+, HMG, Hct, WBCs NIPE: N with children Timolol (Blocadren) [Antihypertensive/BB] WARNING: Exacer- bation of ischemic heart Dz w/ abrupt D/C Uses: *HTN & MI* Action: β-Adren- β β ergic receptor blocker, 1, 2 Dose: HTN: 10–20 mg bid, up to 60 mg/d. MI: 10 mg bid Caution: [C (1st tri; D if 2nd or 3rd tri), +] Contra: CHF, cardiogenic shock, bradycardia, heart block, COPD, asthma Disp: Tabs 5, 10, 20 mg SE: Sexual dysfunction, arrhythmia, dizziness, fatigue, CHF Interactions: ↑ Effects W/ antihypertensives, ciprofloxacin, fentanyl, nitrates, quinidine, reserpine; ↑ bradycardia and myocardial depression W/ cardiac glycosides, diltiazem, reserpine, tacrine, 276 Timolol, Ophthalmic verapamil; ↑ effects OF epinephrine, ergots, flecainide, lidocaine, nifedipine, phenothiazine, prazosin, verapamil; ↓ effects W/ barbiturates, cholestyramine, colestipol, NSAIDs, penicillin, rifampin, salicylates, sulfinpyrazone, theophylline; ↓ effect OF hypoglycemics, sulfonylureas, theophylline Labs: ↑ BUN, K+, LFTs, uric acid NIPE: N D/C abruptly; ↑ cold sensitivity Timolol, Ophthalmic (Timoptic) [Antiglaucoma Agent/BB] Uses: *Glaucoma* Action: β-Blocker Dose: 0.25% 1 gt bid; ↓ to daily when controlled; use 0.5% if needed; 1 gtt/d gel Caution: [C (1st tri; D 2nd or 3rd), ?/+] Disp: Soln 0.25/0.5%; Timoptic XR (0.25, 0.5%) gel-forming soln SE: Local irritation; see Timolol, above Additional NIPE: Depress lacrimal sac 1 min after admin to lessen systemic absorption; admin other drops 10 min before gel Tinidazole (Tindamax) [Antiprotozoal/Anti-infective] WARNING: Off-label use discouraged (animal carcinogenicity w/ other drugs in class) Uses: Adults/children >3 y. *Trichomoniasis & giardiasis; intestinal amebiasis or amebic liver abscess* Action: Antiprotozoal nitroimidazole; Spectrum: T. vagi- nalis, G. duodenalis, E. histolytica Dose: Adults. Trichomoniasis: 2 g PO; Rx partner; Giardiasis: 2 g PO; Amebiasis: 2 g PO daily × 3; Amebic liver abscess: 2 g PO daily × 3–5; Peds. Trichomoniasis: 50 mg/kg PO, 2 g/d max; Giardiasis: 50 mg/kg PO, 2 g max; Amebiasis: 50 mg/kg PO daily × 3, 2 g/d max; Amebic liver abscess: 50 mg/kg PO daily × 3–5, 2 g/d max; w/ food Caution: [C, D in 1st tri; -] May be cross-resistant with metronidazole; Sz/peripheral neuropathy may require D/C; w/ CNS/hepatic impair Contra: Metronidazole allergy, 1st tri PRG, w/ EtOH use Disp: Tabs 250, 500 SE: CNS disturbances; blood dyscrasias, taste disturbances, N/V, darkens urine Interactions: ↑ Effects OF anticoagulants, cyclosporine, fluorouracil, lithium, phenytoin, tacrolimus; ↑ effects W/ cimetidine, ketoconazole; ↑ effects OF abd cramping, N/V, HA W/ disulfram, EtOH; ↓ effects W/ cholestyramine, oxytetra- cycline, phenobarbital, rifampin Labs: ↑ LFTs NIPE: Crush & disperse in cherry syrup for peds; removed by HD; D/C EtOH during & 3 d after Rx Tinzaparin (Innohep) [Anticoagulant/LMW Heparin] WARNING: Risk of spinal/epidural hematomas development w/ spinal anesthesia or lumbar puncture Uses: *Rx of DVT w/ or w/o PE* Action: LMW heparin Dose: 175 units/kg SQ daily at least 6 d until warfarin dose stabilized Caution: [B, ?] Pork allergy, active bleeding, mild–moderate renal dysfunction Contra: Allergy to sulfites, heparin, benzyl alcohol, HIT Disp: Inj 20,000 units/mL SE: Bleeding, bruising, thrombocytopenia, inj site pain Interactions: ↑ Bleeding W/ anticoagulants, NSAIDs, salicylates, thrombolytics Labs: ↑ LFTs; monitor via anti-Xa levels; no effect on: bleeding time, plt Fxn, PT, aPTT NIPE: N Rub inj site, admin deep SQ inj, rotate abd inj sites; causes inj site pain Tioconazole (Vagistat) [Antifungal] Uses: *Vaginal fungal Infxns* Action: Topical antifungal Dose: 1 applicatorful intravag hs (single dose) Caution: [C, ?] Contra: Component allergy Disp: Vag oint 6.5% SE: Local burning, itching, Tobramycin 277 soreness, polyuria Interactions: Risk OF inactivation of nonoxynol-9 sperma- cidal NIPE: Insert high into vag canal; may cause staining of clothing; re- frain from intercourse during drug therapy; risk of latex breakdown of condoms and diaphragm Tiotropium (Spiriva) [Bronchodilator/Anticholinergic] Uses: Bronchospasm w/ COPD, bronchitis, emphysema Action: Synthetic anticholinergic-like atropine Dose: 1 cap/d inhaled using HandiHaler, do not use w/ spacer Caution: [C, ?/–] BPH, NAG, MyG, renal impair Contra: Acute bronchospasm Disp: Inhalation Caps 18 μg SE: URI, xerostomia Interactions: ↑ Effects W/ N other anticholinergic drugs Labs: Monitor FEV1 or peak flow NIPE: For acute resp episode; take daily at same time Tipranavir (Aptivus) [Antiretroviral/Protease Inhibitor] WARNING: Coadministration w/ ritonavir assoc w/ hepatitis & hepatic decomp w/ fatalities. D/C w/ S/Sxs of hepatitis Uses: HIV 1 Infxn w/ highly treatment- experienced pts or HIV 1 strains resistant to multiple protease inhibitors. Must be used w/ ritonavir 200 mg. Action: Antiretroviral HIV-1 protease inhibitor Dose: 500 mg PO bid w/ food, administer w/ ritonavir 200 mg PO bid Caution: [C, –] sulfa allergy, liver Dz Contra: Moderate–severe hepatic insuff; concomitant use w/ amiodarone, astemizole, bepridil, cisapride, ergots, flecainide, lovastatin, midazolam, pimozide, propafenone, quinidine, rifampin, simvastatin, terfenadine, triazolam, St. John’s Wort Disp: Soft gel cap 250 mg; SE: HA, GI distress, rash, fatigue, fat redistribution, hyperglycemia, hepatitis, liver Dz, lipid elevations Interactions: ↑ Effects OF anticoagulants, antiplts, azole antifungals, CCB, clarithromycin, NNRTIs, rifabutin, sildenafil, statins, tadalafil, vardenafil; ↓ effects W/ antacids, didanosine; ↓ effects OF estrogens, methadone Labs: ↑ BS, LFTs, lipids, monitor baseline and periodically NIPE: ↑ Bioavailability W/ high-fat meals; monitor for bleeding in pts w/ hemophilia Tirofiban (Aggrastat) [Antiplatelet Agent] Uses: *Acute coronary synd* Action: Glycoprotein IIB/IIIa inhibitor Dose: Initial 0.4 μg/kg/min for 30 min, followed by 0.1 μg/kg/min; use in combo w/ heparin; ACS or PCI: 0.4 g/kg/min IV for 30 min, then 0.1 μg/kg/min (ECC 2005); ↓ in renal insuff Cau- tion: [B, ?/–] Contra: Bleeding, intracranial neoplasm, vascular malformation, stroke/surgery/trauma w/in last 30 d, severe HTN Disp: Inj 50, 250 μg/mL SE: Bleeding, bradycardia, coronary dissection, pelvic pain, rash Interactions: ↑ Bleeding risks W/ anticoagulants, antiplts, NSAIDs, salicylates, dong quai, feverfew, garlic, ginger, ginkgo, horse chestnut; ↓ effects W/ levothyroxine, omeprazole Labs: ↓ HMG, Hct, plts NIPE: N Breast-feeding Tobramycin (Nebcin) [Antibiotic/Aminoglycoside] Uses: *Se- rious gram(–) Infxns* Action: Aminoglycoside; ↓ protein synth. Spectrum: Gram(–) bacteria (including Pseudomonas sp) Dose: Adults. 1–2.5 mg/kg/dose IV q8–24h. Peds. 2.5 mg/kg/dose IV q8h; ↓ w/ renal insuff Caution: [C, M] Contra: 278 Tobramycin Ophthalmic

Aminoglycoside sensitivity Disp: Inj 10, 40 mg/mL SE: Nephrotox & ototox Notes: Follow CrCl & levels; Levels: Peak: 30 min after inf; Trough: <0.5 h before next dose; Therapeutic: Peak: 5–8 μg/mL, Trough: <2 μg/mL; Toxic peak: > 12 μg/mL; 1/2 life: 2 h Interactions: ↑ Effects W/ indomethacin; ↑ nephrotoxic, neurotoxic, and/or ototoxic effects W/ aminoglycosides, amphotericin B, cephalosporins, cisplatin, IV loop diuretics, methoxyflurane, vancomycin Labs: ↑BUN, Cr; ↓ serum K+, Na+, Ca2+, Mg2+, plt, WBC; NIPE: ↑ Fluids to 2–3 L/d; monitor for super Infxn Tobramycin Ophthalmic (AKTob, Tobrex) [Antibiotic/ Aminoglycoside] Uses: *Ocular bacterial Infxns* Action: Aminoglycoside Dose: 1–2 gtt q4h; oint bid–tid; if severe, use oint q3–4h, or 2 gtt q30–60 min, then less frequently Caution: [C, M] Contra: Aminoglycoside sensitivity Disp: Oint & soln tobramycin 0.3% SE: Ocular irritation; see Tobramycin Additional NIPE: Depress lacrimal sac for 1 min to prevent systemic absorption; ↑ risk of blurred vision & burning Tobramycin & Dexamethasone Ophthalmic (TobraDex) [Antibiotic/Anti-inflammatory] Uses: *Ocular bacterial Infxns associated w/ significant inflammation* Action: Antibiotic w/ anti-inflammatory Dose: 0.3% oint apply q3–8h or soln 0.3% apply 1–2 gtt q1–4h Caution: [C, M] Contra: Aminoglycoside sensitivity Disp: Oint & susp 2.5, 5 & 10 mL tobramycin 0.3% & dexamethasone 0.1% SE: Local irritation/edema; see To- bramycin Additional NIPE: Eval intraocular pressure and lens if prolonged use; use under ophthalmologist’s direction Tolazamide (Tolinase) [Hypoglycemic/Sulfonylurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output Dose: 100–500 mg/d (no benefit >1 g/d) Caution: [C, +/–] Elderly, hepatic or renal impair Disp: Tabs 100, 250, 500 mg SE: HA, dizziness, GI upset, rash, hyperglycemia, photosens, blood dyscrasias Interac- tions: ↑ Effects W/ chloramphenicol, cimetidine, clofibrate, insulin, MAOIs, phenylbutazone, probenecid, salicylates, sulfonamides, garlic, ginseng; ↓ effects W/ diuretics NIPE: Risk of disulfiram-type Rxn w/ EtOH; take w/ food; use sunscreen Tolazoline (Priscoline) [Alpha Adrenergic Antagonist] Uses: *Peripheral vasospastic disorders* Action: Competitively blocks α-adrenergic receptors Dose: Adults. 10–50 mg IM/IV/SQ qid. Neonates. 1–2 mg/kg IV over 10–15 min, then 1–2 mg/kg/h (adjust w/ ↓ renal Fxn) Caution: Avoid alcohol, w/ CAD, renal impairment, CVA, PUD, ↓ BP [C, ?] Contra: CAD Disp: Inj 25 mg/mL SE: ↓ BP, peripheral vasodilation, tachycardia, arrhythmias, GI upset & bleeding, blood dyscrasias, renal failure Interactions: ↓ BP W/ epinephrine, norepinephrine, phenylephrine NIPE: Risk of disulfiram-type Rxn w/ EtOH Tolbutamide (Orinase) [Hypoglycemic/Sulfonylurea] Uses: *Type 2 DM* Action: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output Dose: 500–1000 mg bid; 3 g/d max; ↓ in hepatic failure Caution: [C, +] Contra: Sulfonylurea sensitivity Disp: Tabs 250, Tolterodine 279

500 mg SE: HA, dizziness, GI upset, rash, photosens, blood dyscrasias, hypoglycemia, heartburn Interactions: ↑ Effects W/ anticoagulants, azole antifungals, chloramphenicol, insulin, H2 antagonists, MAOIs, metformin, phenylbutazone, probenecid, salicylates, sulfonamides, TCAs; ↓ effects W/ BBs, CCBs, cholestyramine, corticosteroids, hydantoins, INH, OCPs, phenothiazine, phenytoin, rifampin, sympathomimetics, thiazides, thyroid drugs NIPE: Risk OF disulfiram-type Rxn W/ EtOH; take w/ food; use barrier contraception; ↑ risk OF photosensitivity—use sunscreen Tolcapone (Tasmar) [Anti-Parkinson Agent/COMT Inhibitor] WARNING: Cases of fulminant liver failure resulting in death have occurred Uses: *Adjunct to carbidopa/levodopa in Parkinson Dz* Action: Catechol-O- methyltransferase inhibitor slows levodopa metabolism Dose: 100 mg PO tid w/ 1st daily levodopa/carbidopa dose, then dose 6 & 12 h later; ↓ w/ renal impair Caution: [C, ?] Contra: Hepatic impair; w/ nonselective MAOI Disp: Tabs 100 mg, 200 mg SE: Constipation, xerostomia, vivid dreams, hallucinations, anorexia, N/D, orthostasis, liver failure, Rhabdomyolysis Interactions: ↑ Effects OF CNS depressants, SSRIs, TCAs, warfarin, EtOH; ↑ risk OF hypertensive crisis with nonselective MAOIs (phenelzine, tranylcypromine) Labs: Monitor LFTs NIPE: May give w/o regard to food but food ↓ bioavailability of drug, may experience hallucinations; do not abruptly D/C or ↓ dose Tolmetin (Tolectin) [Analgesic, Anti-inflammatory, Antipyretic/ NSAID] WARNING: May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose: 200–600 mg PO tid; 2000 mg/d max Caution: [C (D in 3rd tri or near term), +] Contra: NSAID or ASA sensitivity; use for pain post CABG Disp: Tabs 200, 600 mg; caps 400 mg SE: Dizziness, rash, GI upset, edema, GI bleeding, renal failure Interactions: ↑ Effect OF aminoglycosides, anticoagulants, cyclosporine, digoxin, insulin, Li, MRX, K-sparing diuretics, sulfonylureas; ↓ effect W/ ASA, food; ↓ effect OF furosemide, thiazides Labs: ↑ ALT, AST, serum K+, BUN, ↓ HMG, Hct NIPE: Take w/ food if GI upset; ↑ risk of photosensitivity—use sunscreen Tolnaftate (Tinactin) [OTC] [Antifungal] Uses: *Tinea pedis, cruris, corporis, manus, versicolor* Action: Topical antifungal Dose: Apply to area bid for 2–4 wk Caution: [C, ?] Contra: Nail & scalp Infxns Disp: OTC 1% Liq; gel; powder; topical cream; oint, powder, spray soln SE: Local irritation NIPE: Avoid ocular contact, Infxn should improve in 7–10 d; N with children <2 y Tolterodine (Detrol, Detrol LA) [Anticholinergic/Muscarinic Antagonist] Uses: *OAB (frequency, urgency, incontinence)* Action: Anti- cholinergic Dose: Detrol 1–2 mg PO bid; Detrol LA 2–4 mg/d Caution: [C, ?/–] w/ CYP2D6 & 3A3/4 inhibitor (Table 11) Contra: Urinary retention, gastric retention, or uncontrolled NAG Disp: Tabs 1, 2 mg; Detrol LA tabs 2, 4 mg SE: Xeros- tomia, blurred vision, headache, constipation Interactions: ↑ Effects W/ azole 280 Topiramate antifungals, macrolides, grapefruit juice, food; ↑ anticholinergic effects W/ amantadine, amoxapine, bupropion, clozapine, cyclobenzaprine, disopyramide, olanzapine, phenothiazine, TCAs NIPE: May cause blurred vision; LA form may see “intact” pill in stool Topiramate (Topamax) [Anticonvulsant] Uses: *Adjunctive Rx for complex partial Szs & tonic–clonic Szs* , bipolar disorder, neuropathic pain, migraine prophylaxis Action: Anticonvulsant Dose: Adults. Sz: Total dose 400 mg/d; see insert for 8-wk titration schedule. Migraine prophylaxis: Titrate 100 m/d total Peds 2–16 y: Initial, 1–3 mg/kg/d PO qhs; titrate per insert to 5–9 mg/kg/d; ↓ w/ renal impair Caution: [C, ?/–] Contra: Component allergy Disp: Tabs 25, 50, 100, 200 mg; caps sprinkles 15, 25, 50 mg SE: Wt loss, memory impair, metabolic acidosis, kidney stones, fatigue, dizziness, psychomotor slowing, paresthesias, GI upset, tremor, nystagmus, acute glaucoma requiring D/C Interactions: ↑ CNS effects W/ CNS depressants, EtOH; ↑ effects OF phenytoin; ↓ effects W/ carbamazepine, phenytoin, valproate, ginkgo biloba; ↓ effects OF digoxin, OCPs Labs: ↑ LFTs NIPE: Take w/o regard to food; N D/C abruptly; use barrier contraception; ↑ fluids to 2–3 L/d; metabolic acidosis responsive to ↓ dose or D/C; D/C requires taper Topotecan (Hycamtin) [Antineoplastic] WARNING: Chemo precautions, for use by health care providers familiar with chemotherapeutic agents, BM suppression possible Uses: *Ovarian CA (cisplatin-refractory), cervical Ca, NSCLC*, sarcoma, ped non-small-cell lung CA Action: Topoisomerase I inhibitor; ↓ DNA synth Dose: 1.5 mg/m2/d as a 1-h IV inf × 5 d, repeat q3wk; ↓ w/ renal impair Caution: [D, –] Contra: PRG, breast-feeding Disp: Inj 4-mg vials SE: ↓ BM, N/V/D, drug fever, skin rash Interactions: ↑ Myelosuppression W/ cisplatin, other neoplastic drugs, radiation therapy; ↑ in duration of neutropenia W/ filgrastim Labs: ↑ AST, ALT, bilirubin; ↓ HMG, Hct, plt, WBCs NIPE: Monitor CBC; N PRG, breast-feeding, immunizations; N exposure to Infxn; use barrier contraception Torsemide (Demadex) [Antihypertensive/Loop Diuretic] Uses: *Edema, HTN, CHF, & hepatic cirrhosis* Action: Loop diuretic; ↓ reabsorption of Na+ & Cl– in ascending loop of Henle & distal tubule Dose: 5–20 mg/d PO or IV; 200 mg/d max Caution: [B, ?] Contra: Sulfonylurea sensitivity Disp: Tabs 5, 10, 20, 100 mg; inj 10 mg/mL SE: Orthostatic ↓ BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes: 20 mg torsemide = 40 mg furosemide Interactions: ↑ Risk of ototox W/ aminoglycosides, cisplatin; ↑ effects W/ thiazides; ↑ effects OF anticoagulants, antihypertensives, Li, salicylates; ↓ effects W/ barbiturates, carbamazepine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid , dandelion Labs: Monitor electrolytes, BUN, Cr, glucose, uric acid NIPE: Take w/o regard to food; monitor for S/Sxs tinnitus Tramadol (Ultram, Ultram ER) [Centrally Acting Anal- gesic/Nonnarcotic] Uses: *Moderate–severe pain* Action: Centrally acting analgesic Dose: Adults. 50–100 mg PO q4–6h PRN, start 25 mg PO qAM, ↑ q3d Trastuzumab 281 to 25 mg PO qid; ↑ 50 mg q3d, 400 mg/d max (300 mg if >75 y); XR 100–300 mg PO daily Peds. 0.5–1 mg/kg PO q4–6h PRN; ↓ w/ renal insuff Caution: [C, ?/–] Contra: Opioid dependency; w/ MAOIs; sensitivity to codeine Disp: Tabs 50 mg; XR 10, 20, 30 mg SE: Dizziness, HA, somnolence, GI upset, resp depression, anaphylaxis Interactions: ↑ Effects W/ antihistamines, CNS depressants, phenothiazine, quinidine, TCAs, EtOH; ↑ risk of serotonin synd W/ MAOIs, St. John’s Wort; ↑ effects OF digoxin, warfarin; ↓ effects W/ carbamazepine Labs: ↑ Cr, LFTs, ↓ HMG NIPE: Take w/o regard to food; ↓ Sz threshold; tolerance or dependence may develop Tramadol/Acetaminophen (Ultracet) [Centrally Acting Anal- gesic/Nonnarcotic] Uses: *Short-term Rx acute pain (<5 d)* Action: Centrally acting analgesic; nonnarcotic analgesic Dose: 2 tabs PO q4–6h PRN; 8 tabs/d max. Elderly/renal impair: Lowest possible dose; 2 tabs q12h max if CrCl <30 Caution: [C, –] Szs, hepatic/renal impair, or h/o addictive tendencies Contra: Acute intox Disp: Tab 37.5 mg tramadol/325 mg APAP SE: SSRIs, TCAs, opioids, MAOIs ↑ risk of Szs; dizziness, somnolence, tremor, HA, N/V/D, constipation, xerostomia, liver tox, rash, pruritus, ↑ sweating, physical dependence Interactions: ↑ Effects W/ CNS depressants, MAOIs, phenothiazines, quinidine, TCAs, EtOH; ↑ risk of serotonin synd W/ MAOIs, St. John’s Wort; ↑ effects OF digoxin, warfarin; ↓ effects W/ carbamazepine Labs: ↑ Cr, LFTs, ↓ HMG NIPE: Take w/o regard to food; N take other acetaminophen-containing drugs; avoid EtOH Trandolapril (Mavik) [Antihypertensive/ACEI] WARNING: Use in PRG in 2nd/3rd tri can result in fetal death Uses: *HTN*, CHF, LVD, post- AMI Action: ACE inhibitor Dose: HTN: 2–4 mg/d; CHF/LVD: 4 mg/d; ↓ w/ severe renal/hepatic impair Caution: [D, +] ACE inhibitor sensitivity, angioedema w/ ACE inhibitors Disp: Tabs 1, 2, 4 mg SE: ↓ BP, bradycardia, dizziness, ↑ K++, GI upset, renal impair, cough, angioedema Notes: Afro-Americans, minimum dose is 2 mg vs 1 mg in Caucasians Interactions: ↑ Effects W/ diuretics; ↑ effects OF insulin, Li; ↓ effects W/ ASA, NSAIDs NIPE: N Take if PRG or breast-feeding; N K-containing salt substitutes Trastuzumab (Herceptin) [Antineoplastic/Monoclonal Anti- body] WARNING: Can cause cardiomyopathy and ventricular dysfunction; infusion Rxns and pulm tox reported Uses: *Met breast CA that over express the HER2/neu protein* breast CA adjuvant, w/ doxorubicin, cyclophosphamide, and paclitaxel if pt HER2/neu(+) Action: MoAb; binds human EGF receptor 2 protein (HER2); mediates cellular cytotox Dose: Per protocol, typical 2 mg/kg/IV/wk Caution: [B, ?] CV dysfunction, allergy/inf Rxns Contra: Live vaccines Disp: Inj form 21 mg/mL SE: Anemia, cardiomyopathy, nephrotic synd, pneumonitis Inter- actions: ↑ Risk of cardiac dysfunction W/ anthracyclines, cyclophosphamide, doxorubicin, epirubicin Labs: Monitor cardiac function; ↓ HMG, Hct, WBCs NIPE: N Use dextrose inf soln; N breast-feed for 6 mo following drug therapy; inf related Rxns minimized w/ acetaminophen, diphenhydramine & meperidine 282 Trazodone

Trazodone (Desyrel) [Antidepressant] WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in pts <24 y Uses: *Depression*, hypnotic, augment other antidepressants Action: Antidepres- sant; ↓ reuptake of serotonin & norepinephrine Dose: Adults & Adolescents. 50–150 mg PO daily–qid; max 600 mg/d. Sleep: 50 mg PO, qhs, PRN Caution: [C, ?/–] Contra: Component allergy Disp: Tabs 50, 100, 150, 300 mg SE: Dizzi- ness, HA, sedation, N, xerostomia, syncope, confusion, tremor, hepatitis, EPS In- teractions: ↑ Effects W/ fluoxetine, phenothiazines; ↑ risk of serotonin syndrome W/ MAOIs, SSRIs, venlafaxine, St. John’s Wort; ↑ CNS depression W/ barbiturates, CNS depressants, opioids, sedatives, EtOH; ↑ hypotension W/ antihypertensive, neuroleptics; nitrates, EtOH; ↑ effects OF clonidine, digoxin, phenytoin; ↓ effects W/ carbamazepine NIPE: Take w/ food; ↑ fluids to 2–3 L/d; N D/C abruptly; ↑ risk of priapism; takes 1–2 wk for symptom improvement Treprostinil Sodium (Remodulin) [Antihypertensive/Va- sodilator] Uses: *NYHA class II–IV pulm arterial HTN* Action: Vasodila- tion, inhibits plt aggregation Dose: 0.625–1.25 ng/kg/min inj cont inf Caution: [B, ?/–] Contra: Component allergy Disp: 1, 2.5, 5, 10 mg/mL inj SE: Additive effects w/ anticoagulants, antihypertensives; inf site Rxns; D (25%), N (22%), HA (27%) Interactions: ↑ Effects W/ antihypertensives; ↑ effects OF anticoagulants NIPE: Teach care of inf site and pump; use barrier contraception; once med vial used discard after 14 d; initiate in monitored setting; do not D/C or ↓ dose abruptly Tretinoin, Topical [Retinoic Acid] (Retin-A, Avita, Renova, Retin- A Micro) [Retinoid/Antineoplastic] Uses: *Acne vulgaris, sun-damaged skin, wrinkles* (photo aging), some skin CAs Action: Exfoliant retinoic acid derivative Dose: Adults & Peds >12 y. Apply daily hs (w/ irritation, ↓ frequency). Photoaging: Start w/ 0.025%, ↑ to 0.1% over several mo (apply only q3d if on neck area; dark skin may require bid use) Caution: [C, ?] Contra: Retinoid sensitivity Disp: Cream 0.02, 0.025, 0.05, 0.1%; gel 0.01, 0.025, micro- formulation gel 0.1, 0.04%; Liq 0.05% SE: Avoid sunlight; edema; skin dryness, erythema, scaling, changes in pigmentation, stinging, photosens Interactions: ↑ photosensitivity W/ quinolones, phenothiazines, sulfonamides, tetracyclines, thiazides, dong quai, St. John’s Wort; ↑ skin irritation W/ topical sulfur, resorcinol, benzoyl peroxide, salicylic acid; ↑ effects W/ vitamin A supl and foods W/ excess vitamin A such as fish oils NIPE: N Apply to mucous membranes, wash skin and apply med after 30 min, wash hands after application; N breast-feeding, PRG use contraception; use sunscreen Triamcinolone (Azmacort) [Anti-inflammatory/Corticos- teroid] Uses: *Chronic asthma* Actions: Topical steroid Dose: Two inhalations tid–qid or 4 inhal bid Caution: [C, ?] Contra: Component allergy Disp: Aerosol, metered inhaler 100 μg spray SE: Cough, oral candidiasis Interactions: ↑ Risk of GI bleed W/ ASA, NSAIDs; ↑ effects W/ salmeterol, troleandomycin; ↓ effects W/ barbiturates, hydantoins, phenytoin, rifampin; ↓ effects OF diuretics, insulin, Triethylenetriphosphamide 283 oral hypoglycemics, K supl, salicylates, somatrem, live virus vaccines Labs: ↑ Glucose, cholesterol; ↓ serum Ca, K+ NIPE: Use bronchodilator several minutes before triamcinolone; allow 1 min between repeat inhalations; instruct pts to rinse mouth after use; not for acute asthma Triamcinolone & Nystatin (Mycolog-II) [Anti-inflammatory, Antifungal/Corticosteroid] Uses: *Cutaneous candidiasis* Action: An- tifungal & anti-inflammatory Dose: Apply lightly to area bid; max 25 mg/d Cau- tion: [C, ?] Contra: Varicella; systemic fungal Infxns Disp: Cream & oint 15, 30, 60, 120 mg SE: Local irritation, hypertrichosis, pigmentation changes Interac- tions: ↓ Effects W/ barbiturates, phenytoin, rifampin; ↓ effects OF salicylates, vaccines NIPE: N Eyes; N apply to open skin/wounds, mucous membranes; for short-term use (<7 d) Triamterene (Dyrenium) [Diuretic/Potassium-Sparing Agent] Uses: *Edema associated w/ CHF, cirrhosis* Action: K+-sparing diuretic Dose: Adults. 100–300 mg/24 h PO ÷ daily–bid. Peds. HTN 2–4 mg/kg/d in 1–2 ÷ doses; ↓ w/ renal/hepatic impair Caution: [B (manufacturer; D ed. opinion), ?/–] Contra: ↑ K+, renal impair; caution w/ other K+-sparing diuretics Disp: Caps 50, 100 mg SE: ↓ K+, blood dyscrasias, liver damage, other Rxns Interactions: ↑ Risk of hyperkalemia W/ ACEIs, K supls, K+-sparing drugs, K-containing drugs, K salt substitutes; ↑ effects W/ cimetidine, indomethacin; ↑ effects OF amantadine, antihypertensives, Li; ↓ effects OF digitalis Labs: ↑ LFTs, BUN, Cr, glucose, uric acid; ↓ HMG, Hct, plt NIPE: Take w/ food, blue discoloration of urine, ↑ risk of photosensitivity—use sunscreen Triazolam (Halcion) [C-IV] [Sedative/Hypnotic/Benzodi- azepine] Uses: *Short-term management of insomnia* Action: Benzodi- azepine Dose: 0.125–0.25 mg/d PO hs PRN; ↓ in elderly Caution: [X, ?/–] Contra: NAG; cirrhosis; concurrent amprenavir, ritonavir, nelfinavir, itraconazole, ketoconazole, nefazodone Disp: Tabs 0.125, 0.25 mg SE: Tachycardia, CP, drowsiness, fatigue, memory impair, GI upset Interactions: ↑ Effects W/ azole antifungals, cimetidine, clarithromycin, ciprofloxin, CNS depressants, disulfiram, digoxin, erythromycin, fluvoxamine, INH, protease inhibitors, troleandomycin, verapamil, EtOH, grapefruit juice, kava kava, valerian; ↓ effects OF levodopa; ↓ effects W/ carbamazepine, phenytoin, rifampin, theophylline NIPE: N PRG or breast-feeding; N D/C abruptly after long-term use; Do not prescribe >1 mo supply Triethanolamine (Cerumenex) [OTC] [Ceruminolytic Agent] Uses: *Cerumen (ear wax) removal* Action: Ceruminolytic agent Dose: Fill ear canal & insert cotton plug; irrigate w/ H2O after 15 min; repeat PRN Caution: [C, ?] Contra: Perforated tympanic membrane, otitis media Disp: Soln 10, 16, 12 mL SE: Local dermatitis, pain, erythema, pruritus NIPE: Warm soln to body temp before use for better effect Triethylenetriphosphamide (Thio-Tepa, Tespa, TSPA) [Alky- lating Agent] Uses: *Hodgkin Dz & NHLs; leukemia; breast, ovarian CAs, 284 Trifluoperazine preparative regimens for allogeneic & ABMT w/ high doses, intravesical for bladder CA* Action: Polyfunctional alkylating agent Dose: 0.5 mg/kg q1–4wk, 6 mg/m2 IM or IV × 4 d q2–4wk, 15–35 mg/m2 by cont IV inf over 48 h; 60 mg into the bladder & retained 2 h q1–4wk; 900–125 mg/m2 in ABMT regimens (highest dose w/o ABMT is 180 mg/m2); 1–10 mg/m2 (typically 15 mg) IT 1 or 2 ×/wk; 0.8 mg/kg in 1–2 L of soln may be instilled intraperitoneally; ↓ in renal failure Caution: [D, –] Contra: Component allergy Disp: Inj 15, 30 mg SE: ↓ BM, N/V, dizziness, HA, allergy, paresthesias, alopecia Interactions:↑ Risk of bleeding W/ anticoagulants, ASA, NSAIDs; ↑ effects OF myelosuppressives; ↑ risk of muscular paralysis W/ neuromuscular blockers; ↑ risk of apnea W/ pancuronium Labs: ↑ Uric acid; ↓ HMG, lymphocytes, neutrophils, plts, RBCs, WBCs NIPE: N PRG, lactation, BM suppression, hepatic dysfunction, renal dysfunction; N ASA or NSAIDs; report s/s of Infxn; intravesical use in bladder CA infrequent today Trifluoperazine (Stelazine) [Antipsychotic/Phenothiazine] Uses: *Psychotic disorders* Action: Phenothiazine; blocks postsynaptic CNS dopaminergic receptors Dose: Adults. 2–10 mg PO bid. Peds 6–12 y. 1 mg PO daily–bid initial, gradually ↑ to 15 mg/d; ↓ in elderly/debilitated pts Caution: [C, ?/–] Contra: h/o blood dyscrasias; phenothiazine sensitivity Disp: Tabs 1, 2, 5, 10 mg; PO conc 10 mg/mL; inj 2 mg/mL SE: Orthostatic ↓ BP, EPS, dizziness, neuroleptic malignant synd, skin discoloration, lowered Sz threshold, photosens, blood dyscrasias Interactions: ↑ CNS depression W/ barbiturates, benzodiazepines, TCAs, EtOH; ↑ effects OF antihypertensives, propranolol, ↓ effects OF anticoagulants ↓ effects W/ antacids Labs: ↑ LFTs; ↓ WBCs NIPE: ↑ Risk of photosensitivity—use sunscreen; urine color may change to pink to reddish-brown; PO conc must be diluted to 60 mL or more prior to administration; requires several wk for onset of effects Trifluridine Ophthalmic (Viroptic) [Antiviral] Uses: *Herpes simplex keratitis & conjunctivitis* Action: Antiviral Dose: 1 gt q2h (max 9 gtt/d); ↓ to 1 gtt q4h after healing begins; Rx up to 21 d Caution: [C, M] Contra: Component allergy Disp: Soln 1% SE: Local burning, stinging NIPE: N <6 y of age; reeval if no improvement in 7 d Trihexyphenidyl (Artane) [Anti-Parkinson Agent/Anti- cholinergic] Uses: *Parkinson Dz* Action: Blocks excess acetylcholine at cerebral synapses Dose: 2–5 mg PO daily–qid Caution: [C, +] Contra: NAG, GI obst, MyG, bladder obst Disp: Tabs 2, 5 mg; SR caps 5 mg; elixir 2 mg/5 mL SE: Dry skin, constipation, xerostomia, photosens, tachycardia, arrhythmia Interac- tions: ↑ Effects W/ MAOIs, phenothiazine, quinidine, TCAs; ↑ effects OF amantadine, anticholinergics, digoxin; ↓ effects W/ antacids, tacrine; ↓ effects OF chlorpromazine, haloperidol, tacrine NIPE: Take w/ food; monitor for urinary hesitancy or retention; N D/C abruptly; ↑ risk of heat stroke Trimethobenzamide (Tigan) [Antiemetic/Anticholinergic] Uses: *N/V* Action: ↓ Medullary chemoreceptor trigger zone Dose: Adults. 250 mg Trimetrexate 285

PO or 200 mg PR or IM tid–qid PRN. Peds. 20 mg/kg/24 h PO or 15 mg/kg/24 h PR or IM in 3–4 ÷ doses Caution: [C, ?] Contra: Benzocaine sensitivity Disp: Caps 100, 250 mg; supp 100, 200, 300 mg; inj 100 mg/mL SE: Drowsiness, ↓ BP, dizziness; hepatic impair, blood dyscrasias, Szs, parkinsonian-like synd Interactions: ↑ CNS depression W/ antidepressants, antihistamines, opioids, sedatives, EtOH; ↑ risk OF extrapyramidal effects NIPE: In the presence of viral Infxns, may mask emesis or mimic CNS effects of Reye synd Trimethoprim (Trimpex, Proloprim) [Antibiotic/Folate An- tagonist] Uses: *UTI due to susceptible gram(+) & gram(–) organisms*; suppression of UTI Action: ↓ Dihydrofolate reductase. Spectrum: Many gram(+) & (–) except Bacteroides sp, Branhamella sp, Brucella sp, Chlamydia sp, Clostrid- ium sp, Mycobacterium sp, Mycoplasma sp, Nocardia sp, Neisseria sp, Pseudomonas sp, & Treponema sp Dose: Adults. 100 mg/d PO bid or 200 mg/d PO. Peds. 4 mg/kg/d in 2 ÷ doses; ↓ w/ renal failure Caution: [C, +] Contra: Megaloblastic anemia due to folate deficiency Disp: Tabs 100, 200 mg; PO soln 50 mg/5 mL SE: Rash, pruritus, megaloblastic anemia, hepatic impair, blood dyscrasias Interactions: ↑ Effects W/ dapsone; ↑ effects OF dapsone, phenytoin, procainamide; ↓ efficacy W/ rifampin Labs: ↑ BUN, Cr, bilirubin NIPE: ↑ Fluids to 2–3 L/d; ↑ risk of folic acid deficiency Trimethoprim (TMP)–Sulfamethoxazole (SMX) [Co-Trimoxa- zole] (Bactrim, Septra) [Antibiotic/Folate Antagonist] Uses: *UTI Rx & prophylaxis, otitis media, sinusitis, bronchitis* Action: SMX ↓ synth of dihydrofolic acid; TMP ↓ dihydrofolate reductase to impair protein synth. Spec- trum: Includes Shigella sp, P. jiroveci (formerly carinii), & Nocardia Infxns, My- coplasma sp, Enterobacter sp, Staphylococcus sp, Streptococcus sp, & more Dose: Adults. 1 DS tab PO bid or 5–20 mg/kg/24 h (based on TMP) IV in 3–4 ÷ doses. P. jiroveci: 15–20 mg/kg/d IV or PO (TMP) in 4 ÷ doses. Nocardia: 10–15 mg/kg/d IV or PO (TMP) in 4 ÷ doses. UTI prophylaxis: 1 PO daily. Peds. 8–10 mg/kg/24 h (TMP) PO ÷ into 2 doses or 3–4 doses IV; do not use in newborns; ↓ in renal failure; maintain hydration Caution: [B (D if near term), +] Contra: Sulfon- amide sensitivity, porphyria, megaloblastic anemia w/ folate deficiency, significant hepatic impair Disp: Regular tabs 80 mg TMP/400 mg SMX; DS tabs 160 mg TMP/800 mg SMX; PO susp 40 mg TMP/200 mg SMX/5 mL; inj 80 mg TMP/ 400 mg SMX/5 mL SE: Allergic skin Rxns, photosens, GI upset, Stevens–Johnson synd, blood dyscrasias, hepatitis Interactions: ↑ Effect OF dapsone, MTX, phenytoin, sulfonylureas, warfarin, zidovudine; ↓ effects W/ rifampin; ↓ effect OF cyclosporine Labs: ↑ Serum bilirubin, alkaline phosphatase, BUN, Cr NIPE: ↑ Risk of photosensitivity—use sunscreen; ↑ fluids to 2–3 L/d; synergistic combo Trimetrexate (Neutrexin) [Anti-infective, Antiprotozoal/ Folic Acid Antimetabolite] WARNING: Must be used w/ leucovorin to avoid tox Uses: *Moderate–severe PCP* Action: ↓ dihydrofolate reductase Dose: 45 mg/m2 IV q24h for 21 d; administer w/ leucovorin 20 mg/m2 IV q6h for 24 d; ↓ in 286 Triptorelin hepatic impair Caution: [D, ?/–] Contra: MTX sensitivity Disp: Inj 25, 200 mg/ 25 mg/vial SE: Sz, fever, rash, GI upset, anemias, ↑ LFTs, peripheral neuropathy, renal impair Interactions: ↑ Effects W/ azole antifungals, cimetidine, erythromycin; ↓ effects W/ rifabutin, rifampin; ↓ effects OF pneumococcal immunization Labs: ↑ LFTs, SCr NIPE: N PRG, breast-feeding use contraception; N exposure to Infxn; use cytotoxic cautions; inf over 60 min Triptorelin (Trelstar Depot, Trelstar LA) [Antineoplastic/Go- nadotropin-Releasing Hormone] Uses: *Palliation of advanced PCa* Action: LHRH analog; ↓ GNRH w/ continuous dosing; transient ↑ in LH, FSH, testosterone, & estradiol 7–10 d after 1st dose; w/ chronic/continuous use (usually 2–4 wk), sustained ↓ LH & FSH w/ ↓ testicular & ovarian steroidogenesis similar to surgical castration Dose: 3.75 mg IM monthly or 11.25 mg IM q3mo Caution: [X, N/A] Contra: Not indicated in females Disp: Inj depot 3.75 mg; LA 11.25 mg SE: Dizziness, emotional lability, fatigue, HA, insomnia, HTN, D, V, ED, retention, UTI, pruritus, anemia, inj site pain, musculoskeletal pain, osteoporosis, allergic Rxns Interactions: ↑ Risk of severe hyperprolactinemia W/ antipsychotics, metoclopropamide Labs: Suppression of pituitary-gonadal Fxn NIPE: N PRG or breast-feeding; may cause hot flashes; initial ↑ bone pain Trospium Chloride (Sanctura) [Antispasmodic/Anticholinergic] Uses: *OAB* Action: Antimuscarinic, antispasmodic Dose: 20 mg PO bid; ↓ w/ renal impair or >75 y; on empty stomach or 1 h ac Caution: [C, ?/–] BOO, GI obst, ulcerative colitis, MyG, renal/hepatic impair Contra: NAG, urinary/gastric retention Disp: Tabs 20 mg SE: Constipation, xerostomia Interactions: ↑ Effects W/ amiloride, digoxin, morphine, metformin, procainamide, tenofovir, vancomycin; ↑ effects OF anticholinergics, amiloride, digoxin, morphine, metformin, procainamide, tenofovir, vancomycin NIPE: Take w/o food 1 h ac Urokinase (Abbokinase) [Thrombolytic Enzyme] Uses: *PE, DVT, restore patency to IV catheters* Action: Converts plasminogen to plasmin; causes clot lysis Dose: Adults & Peds. Systemic effect: 4400 units/kg IV over 10 min, then 4400–6000 units/kg/h for 12 h. Restore catheter patency: Inject 5000 units into catheter & aspirate up to 2 doses Caution: [B, +] Contra: Do not use w/in 10 d of surgery, delivery, or organ biopsy; bleeding, CVA, vascular malformation Disp: Powder for inj, 250,000-unit vial SE: Bleeding, ↓ BP, dyspnea, bronchospasm, anaphylaxis, cholesterol embolism Interactions: ↑ Risk of bleeding W/ anticoagulants, ASA, heparin, indomethacin, NSAIDs, phenylbutazone, feverfew, garlic, ginger, ginkgo biloba; ↓ effects W/ aminocaproic acid Labs: ↑ PT, PTT; ↓ PT, PTT, INR NIPE: Monitor for bleeding q15min for 1st h & q30min for next 7 h Valacyclovir (Valtrex) [Antiviral/Synthetic Purine Nucleo- side] Uses: *Herpes zoster; genital herpes* Action: Prodrug of acyclovir; ↓ viral DNA replication. Spectrum: Herpes simplex I & II Dose: 1 g PO tid. Geni- tal herpes: 500 mg bid × 7–10 d. Herpes prophylaxis: 500–1000 mg/d; ↓ w/ renal Valsartan 287 failure Caution: [B, +] Disp: Caplets 500, 1000 mg SE: HA, GI upset, dizziness, pruritus, photophobia Interactions: ↑ Effects W/ cimetidine, probenecid Labs: ↑ LFTs, Cr ↓ HMG, Hct, plt, WBCs NIPE: Take w/o regard to food; ↑ fluids to 2–3 L/d; begin drug at 1st sign of S/Sxs Valganciclovir (Valcyte) [Antiviral/Synthetic Nucleoside] Uses: *CMV* Action: Ganciclovir prodrug; ↓ viral DNA synth Dose: Induction, 900 mg PO bid w/ food × 21 d, then 900 mg PO daily; ↓ in renal dysfunction Cau- tion: [C, ?/–] Use w/ imipenem/cilastatin, nephrotoxic drugs Contra: Allergy to acyclovir, ganciclovir, valganciclovir; ANC HD <500/mm2; plt <25000; Hgb <8 g/dL Disp: Tabs 450 mg SE: BM suppression, headache, GI upset Interac- tions: ↑ Effects W/ cytotoxic drugs, immunosuppressive drugs, probenecid; ↑ risks of nephrotox W/ amphotericin B, cyclosporine; ↑ effects W/ didanosine Labs: ↑ Cr; monitor CBC & Cr NIPE: Take w/ food; N PRG, breast-feeding, EtOH, NSAIDs; use contraception for at least 3 mo after drug Rx Valproic Acid (Depakene, Depakote) [Anticonvulsant/Car- boxylic Acid Derivative] Uses: *Rx epilepsy, mania; prophylaxis of migraines*, Alzheimer Dz, behavior disorder Action: Anticonvulsant; ↑ availability of GABA Dose: Adults & Peds. Szs: 30–60 mg/kg/24 h PO ÷ tid (after initiation of 10–15 mg/kg/24 h). Mania: 750 mg in 3 ÷ doses, ↑ 60 mg/kg/d max. Migraines: 250 mg bid, ↑ 1000 mg/d max; ↓ w/ hepatic impair Caution: [D, +] Contra: Se- vere hepatic impair Disp: Caps 250 mg; syrup 250 mg/5 mL SE: Somnolence, dizziness, GI upset, diplopia, ataxia, rash, thrombocytopenia, hepatitis, pancreatitis, prolonged bleeding times, alopecia, wt gain, hyperammonemic encephalopathy reported in pts w/ urea cycle disorders Notes: Monitor Levels: Trough: just before next dose; Therapeutic peak: 50–100 μg/mL; Toxic trough: >100 μg/mL; 1/2 life: 5–20 h; phenobarbital & phenytoin may alter levels Interactions: ↑ Effects W/ clarithromycin, erythromycin, felbamate, INH, phenytoin, salicylates, troleandomycin; ↑ effects OF anticoagulants, lamotrigine, nimodipine, phenobarbital, phenytoin, primidone, zidovudine; ↑ CNS depression W/ CNS depressants, haloperidol, loxapine, maprotiline, MAOIs, phenothiazine, thioxanthenes, TCAs, EtOH; ↓ effects W/ cholestyramine, colestipol; ↓ effects OF clozapine, rifampin Labs: ↑ LFTs; altered TFTs; monitor LFTs and serum levels NIPE: Take w/ food for GI upset; N PRG, breast-feeding; D/C abruptly Valsartan (Diovan) [Antihypertensive/ARB] WARNING: Use during 2nd/3rd tri of PRG can cause fetal harm Uses: HTN, CHF, DN Action: An- giotensin II receptor antagonist Dose: 80–160 mg/d, max 320 mg/d Caution: [C (1st tri; D 2nd & 3rd tri), ?/–] w/ K+-sparing diuretics or K+ supls Contra: Se- vere hepatic impair, biliary cirrhosis/obst, primary hyperaldosteronism, bilateral RAS Disp: Tabs 40, 80, 160, 320 mg, caps: 80, 160 mg SE: ↓ BP, dizziness Inter- actions: ↑ Effects W/ diuretics, Li; ↑ risk of hyperkalemia W/ K+-sparing diuretics, K supls, trimethoprim Labs: ↑ K+ NIPE: Take w/o regard to food; N PRG, breast-feeding; use contraception 288 Vancomycin

Vancomycin (Vancocin, Vancoled) [Antibiotic/Glycopeptide] Uses: *Serious MRSA Infxns; enterococcal Infxns; PO Rx of C. difficile pseudomembranous colitis* Action: ↓ Cell wall synth. Spectrum: Gram(+) bacteria & some anaerobes (includes MRSA, Staphylococcus sp, Enterococcus sp, Streptococcus sp, C. difficile) Dose: Adults. 1 g IV q12h; or 15 mg/kg/dose for colitis 125–500 mg PO q6h. Peds. 40–60 mg/kg/24 h IV in ÷ doses q6–12 h. Neonates. 10–15 mg/kg/dose q12h; ↓ in renal insuff Caution: [C, M] Contra: Component allergy; w/ avoid in h/o hearing loss Disp: Caps 125, 250 mg; powder 250 mg/5 mL, 500 mg/6 mL for PO soln; powder for inj 500 mg, 1000 mg, 10 g/ vial SE: Ototoxic & nephrotoxic, GI upset (PO), neutropenia Notes: Levels: Peak: 1 h after inf; Trough: <0.5 h before next dose; Therapeutic peak: 30–40 μg/mL; Trough: <2 μg/mL; Toxic peak: >50 μg/mL; Trough: >15 μg/mL; 1/2 life: 6–8 h Interactions: ↑ Ototox and nephrotox W/ ASA, aminoglycosides, cyclosporine, cisplatin, loop diuretics; ↓ effects OF MRX Labs: ↑ BUN, Cr NIPE: Take w/ food, ↑ fluid to 2–3 L/d; not absorbed PO, local effect in gut only; give IV dose slowly (over 1–3 h) to prevent “red-man synd” (flushing of head/neck/upper torso); IV product PO for colitis Vardenafil (Levitra) [Anti-impotence Agent/PDE5] WARN- ING: May prolong QTc interval Uses: *ED* Action: PDE5 inhibitor, increases cGMP and NO levels; relaxes smooth muscles, dilates cavernosal arteries Dose: 10 mg PO 60 min before sexual activity; 2.5 mg if administered w/ CYP3A4 inhibitors (Table 11); max × 1 =20 mg Caution: [B, –] w/ CV, hepatic, or renal Dz Contra: Nitrates, ↑ Qtc interval Disp: Tabs 2.5, 5, 10, 20 mg tabs SE: Ø BP, HA, dyspepsia, priapism hearing loss Interactions: ↑ Effects W/ erythromycin, ketoconazole indinavir, ritonavir; ↑ risk of hypotension W/α-blockers, nitrates NIPE: Take w/o regard to food; ↑ risk of priapism Varenicline (Chantix) [Nicotinic Acetylcholine Receptor Par- tial Agonist] Uses: *Smoking cessation* Action: Nicotine receptor antagonist Dose: Adults. 0.5 mg PO daily × 3 d, 0.5 mg bid × 4 d, then 1 mg PO bid for 12 wk total; after meal w/ glass of water Caution: [C,?/–] ↓ dose w/ renal impair Disp: Tabs 0.5, 1 mg SE: N, V, insomnia, flatulence, unusual dreams Interactions: May effect metabolism of warfarin, theophylline, insulin; ↑ effects with nicotine replacement drugs NIPE: Slowly ↑ dose to ↓ N; initiate 1 wk before desired smoking cessation date Varicella Virus Vaccine (Varivax) [Vaccine] Uses: *Prevent varicella (chickenpox)* Action: Active immunization; live attenuated virus Dose: Adults & Peds. 0.5 mL SQ, repeat 4–8 wk Caution: [C, M] Contra: Immunocom- promised; neomycin-anaphylactoid Rxn, blood dyscrasias; immunosuppressive drugs; avoid PRG for 3 mo after Disp: Powder for inj SE: Mild varicella Infxn; fever, local Rxns, irritability, GI upset Interactions: ↓ Effects W/ acyclovir, immunosuppressant drugs NIPE: N Salicylates for 6 wk after immunization; N PRG for 3 mo after immunization; OK for all children & adults who have not had chickenpox Verapamil 289

Vasopressin [Antidiuretic Hormone, ADH] (Pitressin) [Antid- iuretic Hormone/ Posterior Pituitary Hormone] Uses: *DI; Rx postop abd distension*; adjunct Rx of GI bleeding & esophageal varices; asystole and PEA pulseless VT & VF, adjunct systemic vasopressor (IV drip) Action: Posterior pituitary hormone, potent GI and peripheral vasoconstrictor Dose: Adults & Peds. DI: 2.5–10 units SQ or IM tid–qid. GI hemorrhage: 0.2–0.4 units/min; ↓ in cirrhosis; caution in vascular Dz. VT/VF: 40 units IVP X1. Vasopressor: 0.01–0.04 units/min Caution: [B, +] Contra: Allergy Disp: Inj 20 units/mL SE: HTN, arrhythmias, fever, vertigo, GI upset, tremor Interactions: ↑ Vasopressor effects W/ guanethidine, neostigmine; ↑ antidiuretic effects W/ carbamazepine, chlorpropamide, clofibrate, phenformin urea, TCAs; ↓ antidiuretic effects W/ demeclocycline, epinephrine, heparin, Li, phenytoin, EtOH Labs: ↑ cortisol level NIPE: Take 1–2 glasses H2O w/ drug; addition of vasopressor to concurrent norepinephrine or epi infs Vecuronium (Norcuron) [Skeletal Muscle Relaxant/Nonde- polarizing Neuromuscular Blocker] Uses: *Skeletal muscle relaxation* Action: Nondepolarizing neuromuscular blocker; onset 2–3 min Dose: Adults & Peds. 0.1–0.2 mg/kg IV bolus (also rapid intubation ECC 2005); maint 0.010–0.015 mg/kg after 25–40 min; additional doses q12–15min PRN; ↓ in severe renal/hepatic impair Caution: [C, ?] Drug interactions cause ↑ effect (eg, aminoglycosides, tetracycline, succinylcholine) Disp: Powder for inj 10, 20 mg SE: Bradycardia, ↓ BP, itching, rash, tachycardia, CV collapse Interactions: ↑ Neuro- muscular blockade W/ amikacin, clindamycin, gentamicin, neomycin, streptomycin, tobramycin, general anesthetics, quinidine, tetracyclines; ↑ resp depression W/ opioids; ↓ effects W/ phenytoin NIPE: Will not provide pain relief or sedation; fewer cardiac effects than succinylcholine Venlafaxine (Effexor, Effexor XR) [Antidepressant/Sero- tonin, Norepinephrine, & Dopamine Reuptake Inhibitor] WARNING: Monitor for worsening depression or emergence of suicidality, particularly in ped pts Uses: *Depression, generalized anxiety*, social anxiety disorder; obsessive–compulsive disorder, chronic fatigue synd, ADHD, autism Action: Po- tentiation of CNS neurotransmitter activity Dose: 75–375 mg/d ÷ into 2–3 equal doses; ↓ w/ renal/hepatic impair Caution: [C, ?/–] Contra: MAOIs Disp: Tabs 25, 37.5, 50, 75, 100 mg; XR caps 37.5, 75, 150 mg SE: HTN, ↑ HR, HA, somnolence, GI upset, sexual dysfunction; actuates mania or Szs Interactions: ↑ Effects W/ cimetidine, desipramine, haloperidol, MAOIs; ↑ risk of serotonin synd W/ sumatriptan,trazodone, St. John’s wort NIPE: XR caps swallow whole—N chew; take w/ food; N use EtOH; N D/C abruptly; D/C MAOI 14 d before start of this drug; ↑ fluids to 2–3 L/d; may take 2–3 wk for full effects; frequent edema & wt gain Verapamil (Calan, Isoptin, Verelan) [Antihypertensive, An- tianginal, Antiarrhythmic/CCB] Uses: *Angina, HTN, PSVT, AF, atrial flutter*, migraine prophylaxis, hypertrophic cardiomyopathy, bipolar Dz Action: 290 Vinblastine

CCB Dose: Adults. Arrhythmias: 2nd line for PSVT w/ narrow QRS complex & adequate BP 2.5–5 mg IV over 1–2 min; repeat 5–10 mg in 15–30 min PRN (30 mg max). Angina: 80–120 mg PO tid, ↑ 480 mg/24 h max. HTN: 80–180 mg PO tid or SR tabs 120–240 mg PO daily to 240 mg bid; 2.5–5.0 mg IV over 1–2 min; repeat 5–10 mg, in 5–30 min PRN; or 5-mg bolus q15min (max 30 mg) (ECC 2005) Peds. <1 y: 0.1–0.2 mg/kg IV over 2 min (may repeat in 30 min). 1–16 y: 0.1–0.3 mg/kg IV over 2 min (may repeat in 30 min); 5 mg max. PO: 1–5 y: 4–8 mg/kg/d in 3 ÷ doses. >5 y: 80 mg q6–8h; ↓ in renal/hepatic impair Caution: [C, +] Amio- darone/β-blockers/flecainide can cause bradycardia; statins, midazolam, tacrolimus, theophylline levels may be ↑; w/ elderly pts Contra: Conduction disorders, cardiogenic shock; β-blocker/thiazide combo, dofetilide, pimozide, ranolazine Disp: Tabs 40, 80, 120 mg; XR tabs 120, 180, 240 mg; tablets XR 24 h 180, 240, mg; inj 5 mg/2 mL SE: Gingival hyperplasia, constipation, ↓ BP, bronchospasm, HR or conduction disturbances Interactions: ↑ Effects W/ antihypertensives, nitrates, quinidine, EtOH, grapefruit juice; ↑ effects OF buspirone, carbamazepine, cyclosporine, digoxin, prazosin, quinidine, theophylline; ↓ effects W/ antineoplastics, barbiturates, NSAIDs; ↓ effects OF Li, rifampin Labs: ↑ ALT, AST, alkaline phosphatase NIPE: Take w/ food; ↑ fluids and bulk foods to prevent constipation Vinblastine (Velban, Velbe) [Antineoplastic/Vinca Alkaloid] WARNING: Chemotherapeutic agent; handle w/ caution Uses: *Hodgkin Dz & NHLs, mycosis fungoides, CAs (testis, renal cell, breast, non-small-cell lung), AIDS-related Kaposi sarcoma*, choriocarcinoma, histiocytosis Action: ↓ Micro- tubule assembly Dose: 0.1–0.5 mg/kg/wk (4–20 mg/m2); ↓ in hepatic failure Cau- tion: [D, ?] Contra: Intrathecal use Disp: Inj 1 mg/mL in 10 mg vial SE: ↓ BM (especially leukopenia), N/V, constipation, neurotox, alopecia, rash, myalgia, tumor pain Interactions: ↑ Effects W/ erythromycin, itraconazole; ↓ effects W/ glutamic acid, tryptophan; ↓ effects OF phenytoin Labs: ↑ Uric acid NIPE: ↑ Flu- ids to 2–3 L/d; N PRG or breast-feeding; use contraception for at least 2 mo after drug; photosensitivity—use sunscreen; N admin immunizations Vincristine (Oncovin, Vincasar PFS) [Antineoplastic/Vinca Alkaloid] WARNING: Chemotherapeutic agent; handle w/ caution; fatal if administered intrathecally Uses: *ALL, breast & small-cell lung CA, sarcoma (eg, Ewing tumor, rhabdomyosarcoma), Wilms tumor, Hodgkin Dz & NHLs, neuroblastoma, multiple myeloma* Action: Promotes disassembly of mitotic spindle, causing metaphase arrest Dose: 0.4–1.4 mg/m2 (single doses 2 mg/max); ↓ in hepatic failure Caution: [D, ?] Contra: Intrathecal use Disp: Inj 1 mg/mL, 5 mg vial SE: Neurotox commonly dose limiting, jaw pain (trigeminal neuralgia), fever, fatigue, anorexia, constipation & paralytic ileus, bladder atony; no significant ↓ BM w/ standard doses; tissue necrosis w/ extrav Interactions: ↑ Effects W/ CCBs, azole antifungals; ↑ risk of bronchospasm W/ mitomycin; ↓ effects OF digoxin, phenytoin, quinolone antibiotics Labs: ↑ Uric acid; ↓ HMG, Hct, plt, WBC Warfarin 291

NIPE: ↑ Fluids to 2–3 L/d; reversible hair loss; N exposure to Infxn; N admin immunizations Vinorelbine (Navelbine) [Antineoplastic/Vinca Alkaloid] WARNING: Chemotherapeutic agent; handle w/ caution Uses: *Breast & non- small-cell lung CA* (alone or w/ cisplatin) Action: ↓ Polymerization of micro- tubules, impairing mitotic spindle formation; semisynthetic vinca alkaloid Dose: 30 mg/m2/wk; ↓ in hepatic failure Caution: [D, ?] Contra: Intrathecal use, rotavirus vaccine line Disp: Inj 10 mg SE: ↓ BM (leukopenia), mild GI, neurotox (6–29%); constipation/paresthesias (rare); tissue damage from extrav Interactions: ↑ Risk of granulocytopenia W/ cisplatin, ↑ pulmonary effects W/ mitomycin, paclitaxel Labs: ↑ LFTs NIPE: N PRG or breast-feeding; use contraception; N infectious environment; ↑ fluids to 2–3 L/d Vitamin B1 See Thiamine Vitamin B6 See Pyridoxine Vitamin B12 See Cyanocobalamin Vitamin K See Phytonadione Vitamin, Multi See Multivitamins (Table 13) Voriconazole (VFEND) [Antifungal/Triazole] Uses: *Invasive aspergillosis, serious fungal Infxns* Action: ↓ Ergosterol synth. Spectrum: Fungus: Aspergillus sp, Scedosporium sp, Fusarium sp Dose: Adults & Peds = 12 y. IV: 6 mg/kg q12h × 2, then 4 mg/kg bid; may ↓ to 3 mg/kg/dose. PO: <40 kg: 100 mg q12h, up to 150 mg; >40 kg: 200 mg q12h, up to 300 mg; ↓ w/ mild–moderate hepatic impair; IV w/ renal impair ×1 dose; PO w/o food Caution: [D, ?/–] Contra: Severe hepatic impair Disp: Tabs 50, 200 mg; susp 200 mg/5 mL; 200 mg inj SE: Visual changes, fever, rash, GI upset Interactions: ↑ Effects W/ delavirdine, efavirenz; ↑ effects OF benzodiazepines, buspirone, CCBs, cisapride, cyclosporine, ergots, pimozide, quinidine, sirolimus, sulfonylureas, tacrolimus; ↓ effects W/ carbamazepine, mephobarbital, phenobarbital, rifampin, rifabutin Labs: ↑ LFTs NIPE: Take w/o food; ↑ risk of photosensitivity—use sunscreen; N PRG or breast-feeding Vorinostat (Zolinza) [Histone Deacetylase Inhibitor] Uses: *Rx cutaneous manifestations in cutaneous T-cell lymphoma* Action: Histone deacetylase inhibitor Dose: 400 mg PO daily w/ food; if intolerant ↓ 300 mg PO d for × 5 d each wk Caution: [D; ?/–] w/ warfarin (↑ INR) Disp: Caps 100 mg SE: N/V/D, dehydration, fatigue, anorexia, dysgeusia, DVT, PE, ↓plt, anemia, hyperglycemia, QTc prolongation Interactions: ↑ Risk of thrombocytopenia & GI bleed W/ HDAC inhibitors (valproic acid) Labs: Monitor CBC, lytes (K, Mg, Ca), glucose, & SCr q2wk × 2 mo then monthly; baseline, periodic ECGs NIPE: Drink 2 L fluid/d; N breastfeeding & <18 y of age Warfarin (Coumadin) [Anticoagulant/Coumarin Derivative] Uses: *Prophylaxis & Rx of PE & DVT, AF w/ embolization*, other postop indications Action: ↓ Vitamin K-dependent clotting factors in order: VII-IX-X-II 292 Zafirlukast

Dose: Adults. Titrate, INR 2.0–3.0 for most; mechanical valves INR is 2.5–3.5. ACCP guidelines: 5 mg initial (unless rapid therapeutic INR needed), may use 7.5–10 mg; ↓ if pt elderly or w/ other bleeding risk factors. Alternative: 10–15 mg PO, or IV daily for 1–3 d; maint 2–10 mg/d PO, IV, or follow daily INR initial to adjust dosage (Table 9). Peds 0.05–0.34 mg/kg/24 h PO, or IV; follow PT/INR to adjust dosage; monitor vitamin K intake; ↓ w/ hepatic impair/elderly Caution: [X, +] Contra: Severe hepatic/renal Dz, bleeding, peptic ulcer, PRG Disp: Tabs 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg; inj SE: Bleeding due to overanticoagulation (PT >3 × control, INR >5.0–6.0) or injury & therapeutic INR; bleeding, alopecia, skin necrosis, purple toe synd Interactions: Common warfarin interactions: ↑ action W/ APAP, EtOH (w/ liver Dz), amiodarone, cimetidine, ciprofloxacin, cotrimoxazole, erythromycin, fluconazole, flu vaccine, isoniazid, itraconazole, metronidazole, omeprazole, phenytoin, propranolol, quinidine, tetracycline. ↓ action W/ barbiturates, carbamazepine, chlordiazepoxide, cholestyramine, dicloxacillin, nafcillin, rifampin, sucralfate, high-vitamin K foods Labs: ↑ PTT; false ↓ serum theophylline levels NIPE: Monitor vitamin K intake (↓ effect); INR preferred test; to rapidly correct overanticoagulation, use vitamin K, FFP or both; reddish discoloration of urine; N PRG or breast-feeding; use barrier contraception; highly teratogenic; caution pt on taking w/ other meds, especially ASA. monitor for bleeding Zafirlukast (Accolate) [Bronchodilator/Leukotriene Recep- tor Antagonist] Uses: *Adjunctive Rx of asthma* Action: Selective & competitive inhibitor of leukotrienes Dose: Adults & Peds = 12 y. 20 mg bid. Peds 5–11 y. 10 mg PO bid (empty stomach) Caution: [B, –] Interacts w/ warfarin, ↑ INR Contra: Component allergy Disp: Tabs 10, 20 mg SE: Hepatic dysfunction, usually reversible on D/C; HA, dizziness, GI upset; Churg–Strauss synd In- teractions: ↑ Effects W/ ASA; ↑ effects OF CCBs, cyclosporine; ↑ risk of bleeding W/ warfarin; ↓ effects W/ erythromycin, theophylline, food Labs: ↑ ALT NIPE: Take w/o food; N use for acute asthma attack Zaleplon (Sonata) [C-IV] [Sedative/Hypnotic] Uses: *Insomnia* Action: A nonbenzodiazepine sedative/hypnotic, a pyrazolopyrimidine Dose: 5–20 mg hs PRN; ↓ w/ renal/hepatic insuff, elderly Caution: [C, ?/–] w/ mental/psychological conditions Contra: Component allergy Disp: Caps 5, 10 mg SE: HA, edema, amnesia, somnolence, photosens Interactions: ↑ CNS depression W/ CNS depressants, imipramine, thoridazine, EtOH; ↓ effects W/ carbamazepine, phenobarbital, phenytoin, rifampin NIPE: Rapid effects of drug-take immediately before desired onset; take w/o food N D/C abruptly Zanamivir (Relenza) [Antiviral/Neuramidase Inhibitor] Uses: *Influenza A & B* Action: ↓ viral neuraminidase Dose: Adults & Peds > 7 y. 2 inhal (10 mg) bid for 5 d; initiate w/in 48 h of Sxs Caution: [C, M] Contra: Pulm Dz Disp: Powder for inhal 5 mg SE: Bronchospasm, HA, GI upset Labs: ↑ ALT, AST, CPK NIPE: Does not reduce risk of transmitting virus; uses a Diskhaler for administration Ziprasidone 293

Ziconotide (Prialt) [Pain Control Agent/Nonnarcotic] WARNING: Psychiatric, cognitive, neurologic impair may develop over several wk; monitor frequently; may necessitate D/C Uses: *IT Rx of severe, refractory, chronic pain* Action: N-type CCB in spinal cord Dose: 2.6 μg/d IT at 0.1 μg/h; may ↑ 0.8 μg/h to total 19.2 μg/d by day 21 Caution: [C, ?/–] Reversible psychiatric/neurologic impair Contra: Psychosis Disp: Inj 25, 100 mg/mL SE: Dizzi- ness, N/V, confusion, abnormal vision; may require dosage adjustment NIPE: May D/C abruptly; uses specific pumps; do not ↑ more frequently than 2–3 ×/wk; monitor for S/Sxs psychotic behavior & meningitis Zidovudine (Retrovir) [Antiretroviral/NRTI] WARNING: Neu- tropenia, anemia, lactic acidosis, & hepatomegaly w/ steatosis Uses: *HIV Infxn, prevention of maternal HIV, transmission of HIV* Action: ↓ RT Dose: Adults. 200 mg PO tid or 300 mg PO bid or 1–2 mg/kg/dose IV q4h. PRG: 100 mg PO 5 ×/d until labor starts; during labor 2 mg/kg over 1 h followed by 1 mg/kg/h until clamping of the cord. Peds. 160 mg/m2/dose q8h; ↓ in renal failure Caution: [C, ?/–] Contra: Allergy Disp: Caps 100 mg; tabs 300 mg; syrup 50 mg/5 mL; inj 10 mg/mL SE: Hematologic tox, HA, fever, rash, GI upset, malaise, myopathy; In- teractions: ↑ Effects W/ fluconazole, phenytoin, probenecid, valproic acid; ↑ hematologic tox W/ adriamycin, dapsone, ganciclovir, interferon-a; ↓ effects W/ rifampin, ribavirin, stavudine NIPE: Take w/o food; monitor for S/Sxs opportunistic Infxn; monitor for anemia Zidovudine & Lamivudine (Combivir) [Antiretroviral/NRTI] WARNING: Neutropenia, anemia, lactic acidosis, & hepatomegaly w/ steatosis Uses: *HIV Infxn* Action: Combo of RT inhibitors Dose: Adults & Peds >12 y. 1 tab PO bid; ↓ in renal failure Caution: [C, ?/–] Contra: Component allergy Disp: Caps zidovudine 300 mg/lamivudine 150 mg SE: Hematologic tox, HA, fever, rash, GI upset, malaise, pancreatitis Interactions: ↑ Effects W/ fluconazole, phenytoin, probenecid, valproic acid; ↑ hematologic tox W/ adriamycin, dapsone, ganciclovir, interferon-a; ↓ W/ rifampin, ribavirin, stavudine NIPE: Take w/o food; monitor for S/Sxs opportunistic Infxn; monitor for anemia; combo product ↓ daily pill burden Zileuton (Zyflo) [Leukotriene Receptor Antagonist] Uses: *Chronic Rx of asthma* Action: Inhibitor of 5-lipoxygenase Dose: Adults & Peds = 12 y. 600 mg PO qid Caution: [C, ?/–] Contra: Hepatic impair Disp: Tabs 600 mg SE: Hepatic damage, HA, GI upset, leukopenia Interactions: ↑ Effects OF propranolol, terfenadine, theophylline, warfarin Labs: ↓ WBCs; ↑ LFTs; monitor LFTs every mo × 3, then q2–3mo; NIPE: Take w/o regard to food; take on a regular basis; not for acute asthma Ziprasidone (Geodon) [Antipsychotic/Piperazine Deriva- tive] WARNING: ↑ Mortality in elderly with dementia-related psychosis Uses: *Schizophrenia, acute agitation* Action: Atypical antipsychotic Dose: 20 mg PO bid, may ↑ in 2-d intervals up to 80 mg bid; agitation 10–20 mg IM PRN up to 294 Zoledronic Acid

40 mg/d; separate 10-mg doses by 2 h & 20 mg doses by 4h (w/ food) Caution: [C, –] w/ ↓ Mg2+, ↓ K+ Contra: QT prolongation, recent MI, uncompensated HF, meds that ↑ QT interval Disp: Caps 20, 40, 60, 80 mg; susp 10 mg/mL; Inj 20 mg/mL; susp 10 mg/mL SE: Bradycardia; rash, somnolence, resp disorder, EPS, wt gain, orthostatic ↓ BP Interactions: ↑ Effects W/ ketoconazole; ↑ effects OF antihypertensives; ↑ CNS depression W/ anxiolytics, sedatives, opioids, EtOH; TCAs, thioridazine; risk of prolonged QT W/ cisapride, chlorpromazine, clarithromycin, diltiazem, erythromycin, levofloxacin, mefloquine, pentamidine, TCAs, thioridazine; ↓ effects W/ amphetamines, carbamazepine; ↓ effects OF levodopa Labs: ↑ Glucose; monitor electrolytes NIPE: May take weeks before full effects, take w/ food, ↑ risk of tardive dyskinesia Zoledronic Acid (Zometa, Reclast) [Antihypercalcemic/ Biphosphonate] Uses: *↑ Ca2+ of malignancy (HCM),↓ skeletal-related events in CAP, multiple myeloma, & met bone lesions (Zometa) postmenopausal osteoporosis, Paget Dz (Reclast)* Action: Bisphosphonate; ↓ osteoclastic bone resorption Dose: HCM: 4 mg IV over at least 15 min; may retreat in 7 d if adequate renal Fxn. Bone lesions/myeloma: 4 mg IV over at least 15 min, repeat q3–4wk PRN; prolonged w/ Cr ↑; Reclast: 5 mg IV annually Caution: [C, ?/–] Loop diuretics, aminoglycosides; ASA-sensitive asthmatics; avoid invasive dental procedures w/ CR Contra: Bisphosphonate allergy; w/ dental procedures Disp: Vial 4 mg, 5 mg SE: all are adverse effects ↑ w/ renal dysfunction; fever, flulike Sxs, GI upset, insomnia, anemia; electrolyte abnormalities, osteonecrosis of jaw Interac- tions: ↑ Risk of hypocalcemia W/ diuretics; ↑ risk of nephrotox W/ aminoglycosides, thalidomide Labs: Follow Cr; effect prolonged w/ Cr increase NIPE: ↑ Fluids to 2–3 L/d; requires vigorous prehydration; do not exceed recommended doses/inf duration to ↓ dose-related renal dysfunction; avoid oral surgery; dental examination recommended prior to therapy; ↓ dose w/ renal dysfunction Zolmitriptan (Zomig, Zomig XMT, Zomig Nasal) [Analgesic Migraine Agent / 5-HT1 Receptor Agonist] Uses: *Acute Rx migraine* Action: Selective serotonin agonist; causes vasoconstriction Dose: Ini- tial 2.5 mg PO, may repeat after 2 h, 10 mg max in 24 h; nasal 5 mg; if HA returns, repeat after 2 h 10 mg max 24 h Caution: [C, ?/–] Contra: Ischemic heart Dz, Prinzmetal angina, uncontrolled HTN, accessory conduction pathway disorders, ergots, MAOIs Disp: Tabs 2.5, 5 mg; Rapid tabs (ZMT) 2.5, 5 mg; nasal 5 mg, SE: Dizziness, hot flashes, paresthesias, chest tightness, myalgia, diaphoresi Interac- tions: ↑ Effects W/ cimetidine, MAOIs, oral contraceptives, propranolol; ↑ risk of prolonged vasospasms W/ ergots; ↑ risk of serotonin synd W/ sibutramine, SSRIs NIPE: Admin to relieve migraines; not for prophylaxis Zolpidem (Ambien, Ambien CR) [C-IV] [Sedative/Hypnotic] Uses: *Short-term Rx of insomnia* Action: Hypnotic agent Dose: 5–10 mg or 12.5 mg CR PO hs PRN; ↓ in elderly (use 6.25 mg CR), hepatic insuff Caution: [B, –] Contra: Breast-feeding Disp: Tabs 5, 10 mg; CR 6.25, 12.5 mg SE: HA, Zoster Vaccine, Live 295 dizziness, drowsiness, N, myalgia Interactions: ↑ CNS depression W/ CNS depressants, sertraline, EtOH; ↑ effects OF ketoconazole; ↓ effects OF rifampin NIPE: Take w/o food; N DC abruptly if long-term use; may develop tolerance to drug; may be habit-forming; CR delivers a rapid then a longer lasting dose Zonisamide (Zonegran) [Anticonvulsant/Sulfonamide] Uses: *Adjunct Rx complex partial Szs* Action: Anticonvulsant Dose: Initial 100 mg/d PO; may ↑ to 400 mg/d Caution: [C, –] ↑ tox w/ CYP3A4 inhibitor; ↓ levels w/ concurrent carbamazepine, phenytoin, phenobarbital, valproic acid Contra: Al- lergy to sulfonamides; oligohydrosis & hypothermia in peds Disp: Caps 25, 50, 100 mg SE: Dizziness, drowsiness, confusion, ataxia, memory impair, paresthesias, psychosis, nystagmus, diplopia, tremor, anemia, leukopenia; GI upset, nephrolithiasis, Stevens–Johnson synd Interactions: ↑ Tox W/ CYP3A4 inhibitor; ↓ effects W/ carbamazepine, phenobarbital, phenytoin, valproic acid Labs: ↑ Serum alkaline phosphatase, ALT, AST, creatinine, BUN, ↓ glucose, Na NIPE: N D/C abruptly; swallow capsules whole; monitor for ↓ sweating & ↑ body temperature Zoster Vaccine, Live (Zostavax) [Vaccine] Uses: * Prevent varicella zoster in adults >60 y* Action: Active immunization (live vaccine), to Herpes zoster Dose: Adults. 0.65 mL SQ Contra: Gelatin, neomycin anaphylaxis; untreated TB, immunocompromised Caution: [C,?/–] Not for peds Disp: SDV SE: Inj site Rxn, HA Interactions: ↑ Risk of extensive rash W/ corticosteroids NIPE: N PRG for at least 3 mo > vaccination; once reconstituted use immediately COMMONLY USED MEDICINAL HERBS

The following is a guide to some common herbal products. These may be sold separately or in combination with other products. According to the FDA: “Manufac- turers of dietary supplements can make claims about how their products affect the structure or function of the body, but they may not claim to prevent, treat, cure, mitigate, or diagnose a disease without prior FDA approval.”

Aloe Vera (Aloe barbadensis) Uses: Topically for burns, skin irritation, sunburn, wounds; internally used for constipation, amenorrhea, asthma, colds Actions: multiple chemical components; aloinosides inhibit H2O & electrolyte reabsorption & irritates colon which ↑ peristalsis & propulsion; wound healing d/t ↓ production of thromboxane A2, inhibiting bradykinin & histamine; Available forms: Apply gel topically 3–5/d PRN; caps 100–200 mg PO hs Contra: N Inter- nally if PRG, lactating, or in children <12 y Notes/SE: Abd cramping, D, edema, hematuria, hypokalemia, muscle weakness, dermatitis Interactions w/ internal use: ↑ K+ loss W/ BB, corticosteroids, diuretics, licorice; ↑ effects OF antiarrhythmics, corticosteroids, digoxin, diuretics, hyperglycemias, jimsonweed Labs: ↓ K+, BS NIPE: Assess for dehydration, electrolyte imbalance, abd distress W/ internal use; stimulates uterine contractions & may cause spontaneous abortion Arnica (Arnica montana) Uses: ↓ Swelling & inflammation from acne, blunt injury, bruises, rashes, sprains Action: Sesquiterpenoids have shown antibacterial, anti-inflammatory, & analgesic properties Available forms: Topical cream, spray, oint, tinc; for poultice dilute tinc 3–10 × w/ water & apply PRN Contra: Poisonous, N take internally; N if pt allergic to arnica, chrysanthemums, marigold, sunflowers Notes/SE: Arrhythmias, abd pain, cardiac arrest, contact dermatitis, coma, death, hepatic failure, HTN, nervousness, restlessness Interactions: ↑ Risk of bleeding W/ ASA, heparin, warfarin, angelica, anise, asafetida, bogbean, boldo, capsicum, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, pa- pain, passion flower, poplar bark, prickly ash, quassia wood, red clover, turmeric, wild carrot, wild lettuce, willow; ↓ effects OF antihypertensives Labs: None NIPE: N Apply to broken skin, N use in PRG & lactation, serious liver & kidney damage w/ internal use, ingestion of flowers & root can cause death, prolonged topical use ↑ risk of allergic reaction Astragalus (Astragalus membranaceus) Uses: Rx of resp In- fxns, enhancement of immune system, & HF Action: Root saponins ↑ diuresis, ↓ BP; anti-inflammatory action related to the stimulation of macrophages, ↑ antibody 296 Copyright © 2009 by Judith A. Barberio. Click here for terms of use. Bogbean 297 formation & ↑ T-lymphocyte proliferation Available forms: Caps/tabs 1–4 g tid, PO; Liq ext 4–8 mL/d (1:2 ratio) %doses; dry ext 250 mg (1:8 ratio) tid, PO Notes/SE: Immunosuppression w/ doses >28 g Interactions: ↑ Effect OF acyclovir, anticoagulants, antihypertensives, antithrombotics, antiplts, interleukin-2, interferon; ↓ effect OF cyclophosphamide Labs: ↑ PT, INR NIPE: Use cautiously in immunosuppressed pts or those w/ autoimmune Dz Bilberry (Vaccinium myrtillus) Uses: Prevent/treat visual problems such as cataract, retinopathy, myopia, glaucoma, macular degeneration; treat vascular problems such as hemorrhoids, & varicose veins Actions: Contain anthocyani- dins that ↓ vascular permeability, inhibit plt aggregation & thrombus formation, ↑ antioxidant effects on LDLs & liver, ↑ regeneration of rhodopsin in retina Avail- able forms: Products should have 25% anthocyanoside content; caps, extracts, dried, or fresh fruit, leaves; eye/vascular problems 240–480 mg PO bid/tid; night vision 60–120 mg of extract PO OD Contra: N PRG or lactation; caution in patients with DM and bleeding disorders Notes/SE: Constipation Interactions:↑ Effects OF anticoagulants, antiplts, insulin, NSAIDs, oral hypoglycemics, ↓ effects OF Fe Labs: ↑ PT; ↓ glucose, plt aggregation NIPE: Large dose of leaves for long periods of time may be poisonous/fatal; take w/o regard to food Black Cohosh (Cimicifuga racemosa) Uses: Antitussive; smooth- muscle relaxant; management of menopausal symptoms esp hot flashes, sleep disturbance & anxiety, premenstrual synd, & dysmenorrhea. Anti-inflammatory, peripheral vasodilation, & sedative effects Action: Estrogenic activity w/ some studies showing ↓ in LH; vasodilation activity causing ↑ blood flow & hypotensive effects; antimicrobial activity Available forms: Dried root/rhizome caps 40–200 mg once/d; fluid ext (1:1) 2–4 mL or 1 tsp once/d; tinc (1:5) 3–6 mL or 1–2 tsp once/d; powdered ext (4:1) 250–500 mg once/d; Remifemin menopause (standardized ext brand name) 20 mg bid Notes/SE: Hypotension, bradycardia, N/V, anorexia, HA, miscarriage, nervous system & visual disturbances Interactions: ↑ Effects OF antihypertensives, estrogen HRT, OCPs, hypnotics, sedatives; tinc may cause a reaction W/ disulfiram & metronidazole; ↑ antiproliferative effect W/ tamoxifen; ↓ effects OF ferrous fumarate, ferrous gluconate, ferrous sulfate Labs: May ↓ LH levels & plt counts NIPE: Tinc contains large % of EtOH, N use in PRG or lactation or give to children Bogbean (Menyanthes trifoliate) Uses: ↑ Appetite; treat GI distress; anti-inflammatory for arthritis; Action: Several chemical constituents include alkaloids (choline, gentianin, gentianidine), flavonoids (hyperin, kaempferol, quercetin, rutin, trifolioside) that act as an anti-inflammatory, and acids (caffeic, chlorogenic, ferulic, folic, palmitic, salicylic, vanillic) that act as bile stimulants & other elements such as carotene, ceryl alcohol, coumarin, iridoid, scopoletin; two compounds produce considerable inhibition of prostaglandin synthesis Available Forms: Extract (1:1 dilution) 1–2 mL PO tid with fluid; dried leaf as tea 1–3 g PO tid Contra: N PRG or lactating Notes/SE: N/V, bleeding Interactions: ↑ Risk of 298 Borage bleeding W/ anticoagulants, antiplts, ANA, NSAIDs; ↑ Effects OF stimulant laxi- tives; ↓ effects OF antacids, H2 antagonists, proton pump inhibitors, sucralfate Labs: None NIPE: May ↑ uterine contractions; extracts contain EtOH; monitor for S/Sxs bleeding or ↑ bruising; N if h/o colitis, anemia Borage (Borage officinalis) Uses: Oil used for eczema & dermatitis & as a GLA supplement; treat colds, coughs, & bronchitis; anti-inflammatory action used to treat arthritis Action: Oil contains GLA & its metabolites produce anti- inflammatory action; topical oil absorbed in skin ↑ fluid retention in stratum corneum; mucilage & malic acid components have expectorant & diuretic actions; contains alkaloids that are hepatotoxic Available forms: Caps with 10–25% GLA; 1.1–1.4 g GLA PO OD for joint inflammation; oil topical application bid for dermatitis & eczema Contra: N PRG, lactation, & pts with h/o liver Dz or Sz disorder Notes/SE: ↑ Constipation, flatulence, liver dysfunction, Sz Interactions: ↑ Risk of bleeding W/ anticoagulants, antiplts; ↑ effects OF antihypertensives; ↓ effects OF anticonvulsants, phenothiazine, TCAs; ↓ effects of herb W/ NSAIDs Labs: Monitor LFTs; may ↑ LFTs, PT & INR NIPE: Only use herb without UPA alkaloids Bugleweed (Lycopus virginicus) Uses: ↓ Hyperthyroid symptoms, analgesic, astringent Action: inhibits gonadotropin, prolactin, TSH & IgG antibody activity Available forms: Teas, extracts, dried herb Contra: N PRG or lactation, pts with hypothyroidism, pituitary or thyroid tumors, hypogonadism, & CHF Notes/SE: Thyroid gland enlargement Interactions: ↑ Effects OF insulin, oral hypoglycemics, ↑ thyroid suppressing effects W/ balm leaf & wild thyme plant; ↓ effect OF thyroid hormone Labs: ↓ FSH, LH, HCG, TSH; monitor BS NIPE: N Substitute for antithyroid drugs; N if undergoing treatment or diagnostic procedures with radioisotopes; N stop abruptly Butcher’s Broom (Ruscus aculeatus) Uses: Rx of circulatory disorders such as PVD, varicose veins, & leg edema; hemorrhoids; diuretic; laxative; inflammation; arthritis Action: Vasoconstriction due to direct activation of the α-receptors of the smooth-muscle cells in vascular walls Available forms: Raw ext 7–11 mg once/d, PO; tea 1 tsp in 1 cup water; topical oint apply PRN Notes/SE: GI upset, N/V Interactions: ↑ Effects OF anticoagulants, MAOIs; ↓ effects OF antihypertensives Labs: None NIPE: Hypertensive crisis may occur if admin w/ MAOIs; N use in PRG & lactation Capsicum (Capsicum frutescens) Uses: Topical use includes pain relief from arthritis, diabetic neuropathy, postherpetic neuralgia, postsurgical pain; internal uses include circulatory disorders, GI distress, HTN Actions: Stimulates skin pain receptors causing burning sensations; desensitization of pain receptors results in pain relief; ↓ lymphocyte production, antibody production, & plt aggregation Available forms: Topical creams 0.025–0.25% up to qid; caps 400–500 mg PO tid Contra: N On open sores, in PRG, children <2 y Notes/SE: GI irritation, sweating, bronchospasm, respiratory irritation, topical burning, stinging, erythema Comfrey 299

Interactions:↑ Effects OF anticoagulants, antiplts, theophylline; ↑ risk of cough W/ ACEIs; ↑ risk of anticoagulant effects W/ feverfew, garlic, ginger, ginkgo, ginseng; ↑ risk of hypertensive crisis W/ MAOIs; ↓ effects OF clonidine, methyldopa Labs: None NIPE: Pain relief may take several weeks; N apply heat on areas W/ topical capsicum cream; avoid contact W/ eyes or mucous membranes Cascara (Rhamnus purshiana) Uses: Laxative Action: Stimulates large intestine, ↑ bowel motility & propulsion, Available forms: Liq extract 1–5 mL PO OD; Contra: N PRG, lactation & IBD Notes/SE: N/V, abd cramps, urine discoloration, osteomalacia Interactions: ↑ Effects OF antiarrhythmics, cardiac glycosides; ↑ K+ loss W/ diuretics, corticosteroids, cardiac glycosides; ↓ effects W/ antacids, milk Labs: ↓ serum K+ NIPE: Short-term use; monitor electrolytes; caution w/diuretics Chamomile (Matricaria recutita) Uses: Anti-inflammatory, antipyretic, antimicrobial, antispasmodic, astringent, sedative Action: Ingredients include α-bisabolol oil, which ↓ inflammation, antispasmodic activity, ↑ healing times for burns & ulcers, & inhibits ulcer formation; apigenin contributes to the anti-inflammatory effect, antispasmodic & sedative effect; azulene inhibits histamine release; chamazulene reduces inflammation & has antioxidant & antimicrobial effects Available forms: Teas 3–5 g (1 tbsp) flower heads steeped in water tid–qid, also use as a gargle or compress; fluid ext 1:1 -45% EtOH 1–3 mL tid Notes/SE: Allergic reactions if pt allergic to Compositae family (ragweed, sunflowers, asters) eg, angioedema, eczema, contact dermatitis & anaphylaxis Inter- actions: ↑ Effects OF CNS depressants, EtOH, anticoagulants, antiplts; ↑ risk OF miscarriage; ↓ effects OF drugs metabolized by CY4503A4, eg, alprazolam, atorvastatin, diazepam, ketoconazole, verapamil Labs: Monitor anticoagulant levels NIPE: N PRG, lactation, children <2 y, pt w/ asthma or hay fever Chondroitin Sulfate Uses: Combine w/ glucosamine to Rx arthritis; use as an anticoagulant Action: Attracts fluid & nutrients into the joints; inhibits thrombi Available forms: 1200 mg once/d, PO, & usually given w/ glucosamine 1500 mg once/d, PO for nl wt adults Notes/SE: D, dyspepsia, HA, N/V, restlessness Inter- actions: ↑ Effects OF anticoagulants, ASA, NSAIDs Labs: None NIPE: N PRG & lactation Comfrey (Symphytum officinale) Uses: Topical treatment of wounds, bruises, sprains, inflammation Action: Multiple chemical components, al- lantoin promotes cell division, rosmarinic acid has anti-inflammatory effects, tannin possesses astringent effects, mucilage is a demulcent with anti-inflammatory properties, pyrrolizidine alkaloids cause hepatotox Available forms: Topical application w/ 5–20% of herb applied on intact skin for up to 10 d Contra: N Internally d/t hepatotox, N PRG or lactation Notes/SE: N/V, exfoliative dermatitis w/ topical use Interactions: ↑ Risk of hepatotox W/ ingestion of borage, golden ragwort, hemp, petasties Labs:↑ LFTs, total bilirubin, urine bilirubin NIPE: N Use for more than 6 wk in 1 y; N use on broken skin 300 Coriander

Coriander (Coriandrum sativum) Uses: ↑ Appetite, treat D, dyspepsia, flatulence Action: Stimulates gastric secretions, spasmolytic effects Available forms: Tinc 10–30 gtts PO OD; Contra: N PRG or lactation Notes/SE: N/V, fatty liver tumors, allergic skin Rxns Interactions: ↑ Effects OF oral hypoglycemics Labs: Monitor BS NIPE: ↑ Risk of photosensitivity—use sunscreen Cranberry (Vaccinium macrocarpon) Uses: Prevention UTI; urinary deodorizer in urinary incontinence Actions: Interferes with bacterial adherence to epithelial cells of the bladder Available forms: Caps 300–500 mg PO bid–qid; unsweetened juice 8–16 oz daily; tinc 3–5 mL SE: D, irritation, nephrolithiasis if ↑ urinary Ca oxalate Interactions: ↑ Excretion of alkaline drugs such as antidepressants & methotrexate will cause ↓ effectiveness OF drug, ↓ effectiveness OF Uva-ursi; Labs: ↑ Urine pH NIPE: Not effective in treating UTI; tinc contains up to 45% EtOH; only unsweetened form effective; regular use may ↓ frequency of bacteriuria with pyria Dong Quai (Angelica polymorpha, sinensis) Uses: Dysmenor- rhea, PMS, menorrhagia, chronic pelvic Infxn, irregular menstruation. Other reported uses include anemia, HTN, HA, rhinitis, neuralgia, & hepatitis Action: Root exts contain at least 6 coumarin derivatives that have anticoagulant, vasodilat- ing, antispasmodic, & CNS-stimulating activity. Studies demonstrate weak estrogen-agonist actions of the ext Available forms: Caps 500 mg, 1–2 caps PO, tid; Liq ext 1–2 gtt, tid; tea 1–2 g, tid Notes/SE: D, bleeding, photosensitivity, fever Interactions: ↑ Effects OF anticoagulants, antiplts, estrogens, warfarin; ↑ anticoagulant activity W/ chamomile, dandelion, horse chestnut, red clover; ↑ risk of disulfiram-like reaction W/ disulfiram, metronidazole Labs: ↑ PT, PTT, INR NIPE: Photosensitivity—use sunscreen, N if breast-feeding or PRG; tincs & exts contain EtOH up to 60%; stop herb 14 d prior to dental or surgical procedures Echinacea (Echinacea purpurea) Uses: Immune system stimulant; prevention/Rx of colds, flu; as supportive therapy for colds & chronic Infxns of the resp tract & lower urinary tract Action: Stimulates phagocytosis & cytokine production & ↑ resp cellular activity; topically exerts anesthetic, antimicrobial, & anti- inflammatory effects Available forms: Caps w/ powdered herb equivalent to 300–500 mg, PO, tid; pressed juice 6–9 mL, PO, once/d; tinc 2–4 mL, PO, tid (1:5 dilution); tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Notes/SE: Fever, taste perversion, urticaria, angioedema Contra: N In pts w/ autoimmune Dz, collagen Dz, HIV, leukemia, MS, TB Interactions: ↑ Risk of disulfiram-like reaction W/ disulfiram, metronidazole; ↑risk of exacerbation of HIV or AIDS W/ echinacea & amprenavir, other protease inhibitors; ↓ effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus Labs: ↑ ALT, AST, lymphocytes, ESR NIPE: Large doses of herb interferes w/ sperm activity; N w/ breast- feeding or PRG; N continuously for longer than 8 wk w/o a 3-wk break in Rx Garlic 301

Ephedra/Ma Huang Uses: Stimulant, aid in wt loss, bronchial dilation Dose: Not OK d/t reported deaths (>100 mg/d can be life-threatening). US sales banned by FDA in 2004; bitter orange w/ similar properties has replaced this compound in most wt loss supplements Caution: Adverse cardiac events, strokes, death SE: Nervousness, HA, insomnia, palpitations, V, hyperglycemia Interac- tions: Digoxin, antihypertensives, antidepressants, DA medications Labs: ↑ ALT, AST, total bilirubin, urine bilirubin, serum glucose NIPE: Tincs & exts contain EtOH; linked to several deaths; monitor for behavioral mood changes Evening Primrose Oil (Oenothera biennis) Uses: PMS, diabetic neuropathy, ADHD, IBS, RA, mastalgia Action: Anti-inflammatory, antispasmodic, diuretic, sedative effects related to a high concentration of essential fatty acids especially GLA & CLA & their conversion into prostaglandins Available forms: Caps, gel-caps, Liq. dose depends on GLA content. DM neuropathy: 4000 mg–6000 mg PO OD; Eczema 4000 mg PO OD; Mastalgia 3000 mg–4000 mg PO ÷ doses; PMS: 2000 mg–4000 mg PO OD; RA: Up to 5000 mg PO OD Notes/SE: Indigestion, N, soft stools, flatulence, HA , anorexia, rash Contra: N PRG or lactation; N persons with Sz disorders Interactions: ↑ Phenobarbital metabolism, ↓ Sz threshold, ↑ effects OF diuretics, sedatives Labs: None NIPE: May take up to 4 mo for max effectiveness, take w/ food Feverfew (Tanacetum parthenium) Uses: Anti-inflammatory for arthritis, asthma, digestion problems, fever, migraines, menstrual complaints, threatened abortion Action: Active ingredient, parthenolide, inhibits serotonin release, prostaglandin synthesis, plt aggregation, & histamine release from mast cells; several ingredients inhibit activation of polymorphonuclear leukocytes & leukotriene synthesis Available forms: Freeze-dried leaf ext 25 mg once/d; caps 300 mg–400 mg tid PO; tinc 15–30 gtt once/d to 0.2–0.7 mg of parthenolide Notes/SE: Mouth ulcers, muscle stiffness, joint pain, GI upset, rash Contra: N PRG & lactation or w/ ragweed allergy Interactions: ↑ Effects OF anticoagulants, antiplts, ↓ effects OF Fe absorption Labs: ↑ PT, INR, PTT NIPE: N D/C herb abruptly or may experience joint stiffness & pain, headaches, insomnia Fish Oil Supplements (Omega-3 Polyunsaturated Fatty Acid): Uses: CAD, hypercholesterolemia, hypertriglyceridemia, type 2 DM, arthritis Efficacy: No definitive data on ↓ cardiac risk in general population; may ↓ lipids and help w/ secondary MI prevention Dose: One FDA approved; OTC 1500–3000 mg/d; AHA recommends 1 g/d Caution: Mercury contamination possible, some studies suggest ↑ cardiac events SE: ↑ Bleed risk, dyspepsia, belching, aftertaste Interactions: Anticoagulants Garlic (Allium sativum) Uses: Antithrombotic, antilipidemic, antitu- mor, antimicrobial, antiasthmatic, anti-inflammatory Action: Inhibits gram(+) & gram(–) organisms, exerts cholesterol-lowering by preventing gastric lipase fat digestion & fecal excretion of sterols & bile acids & it inhibits free radicals Avail- able forms: Teas, tabs, caps, ext, oil, dried powder, syrup, fresh bulb Notes/SE: 302 Gentian

Dizziness, diaphoresis, HA, N/V, hypothyroidism, contact dermatitis, allergic reactions, oral mucosa irritation, systemic garlic odor, ↓ Hgb production, lysis of RBCs Interactions: ↑ Effects OF anticoagulants, antiplts, insulin, oral hypoglycemics; ↓ effects W/ acidophilus Labs: ↓ Total cholesterol, LDL, triglycerides, plt aggregation, iodine uptake; ↑ PT, serum IgE NIPE: N PRG, lactation, prior to surgery, GI disorders; report bleeding, bruising, petechiae, tarry stools, monitor CBC, PT Gentian (Gentiana lutea) Uses: ↑ Appetite, treat digestive disorders such as colitis, IBS, flatulence Actions: Chemical components stimulate digestive juices Available forms: Liq extract 2–4g PO OD, tinc 1–3 g PO OD, dried root 2–4 g PO OD Contra: N PRG, lactation, & HTN Notes/SE: N/V, HA Interactions:↑ CNS sedation W/ barbiturates, benzodiazepines, EtOH if extract/tinc contains alcohol; ↓ absorption OF Fe salts Labs: None NIPE: Caution—many herb preps contain up to 60% EtOH Ginger (Zingiber officinale) Uses: Antiemetic ↓ N/V; anti-inflammatory relieves pain & swelling of muscle injury, osteoarthritis & RA; antispasmodic action relieves colic, flatulence & indigestion; antiplt; antipyretic; antioxidant; antiinfective against gram(+) & gram(–) bacteria Action: Anti-inflammatory effect inhibits prostaglandin, thromboxane, & leukotriene biosynthesis; antiemetic effects due to action on the GI tract; antiplt effect due to the inhibition of thromboxane formation; + inotropic effect on CV system Available forms: Dosage form & strength depends on Dz process General use: Dried ginger caps 1 g once/d, PO; fluid ext 0.7–2 mL once/d, PO, (2:1 ratio); tabs 500 mg bid–qid, PO; tinc 1.7–5 mL once/d, PO, (1:5 ratio) Interactions: ↑ Risk of bleeding W/ anticoagulants, antiplts; ↑ risk of disulfiram-like reaction W/ disulfiram, metronidazole Labs: ↑ PT NIPE: Store herb in cool, dry area; N PRG, lactation; lack of standardization for herb dosing Ginkgo Biloba Uses: Effective w/ circulatory disorders, cerebrovascular Dz, & dementia; used to improve alertness & attention span Action: Ext flavonoids release neurotransmitters & inhibit monoamine oxidase, which enhances cognitive function; vascular protective action results from relaxation of blood vessels, ↑ tissue perfusion, inhibition of plt aggregation; eradicates free radicals & ↓ polymorphonuclear neutrophils Available forms: Dosage depends on diagnosis General uses: Tabs & caps 40–80 mg tid, PO; tinc 0.5 mL tid, PO; ext 40–80 mg tid, PO Notes/SE: Anxiety, D, flatulence, HA, heart palpitations, N/V, restlessness Interactions: ↑ Effect OF MAOIs; ↑ risk of bleeding W/ anisindione, dalteparin, dicumarol garlic, heparin, salicylates, warfarin; ↑ risk of coma W/ trazodone; ↑ effect OF carbamazepine, gabapentin, insulin, oral hypoglycemics, phenobarbital, phenytoin; ↓ seizure threshold W/ bupropion, TCAs Labs: ↑ PT NIPE: N PRG & lactation; tincs contain up to 60% EtOH; N 2 wk prior to surgery Ginseng (Panax quinquefolius) Uses: ↑ Physical endurance, concentration, appetite, sleep & stress resistance; ↓ fatigue; antioxidant; aids in glucose control Action: Dried root contains ginsenosides, which ↑ natural killer cell activity, & nuclear RNA synthesis, & motor activity Available forms: No standard Guarana 303 dosage General use: Caps 200 mg–500 mg once/d, PO; tea 3 g steeped in boiling water tid PO, tinc 1–2 mg once/d, PO (1:1 dilution) Notes/SE: Anxiety, anorexia, chest pain, D, HTN, N/V, palpitations Interactions: ↑ Effects OF estrogen, hypoglycemics, CNS stimulants, caffeine, ephedra; ↑ risk of bleeding W/ ibuprofen; ↑ risk OF HA, irritability & visual hallucinations W/ MAOIs; ↓ effects OF anisindione, dicumarol, furosemide, heparin, warfarin Labs: ↑ Digoxin level falsely; ↓ glucose, PT, INR NIPE: N Use continuously for >3 mo; N during PRG or lactation; eval for ginseng abuse syndrome w/ symptoms of D, depression, edema, HTN, insomnia, rash & restlessness Glucosamine Sulfate (chitosamine) Uses: Used w/ chondroitin for the Rx of arthritis Action: Stimulate the production of cartilage components Avail- able forms: Caps/tabs 1500 mg once/d, PO & chondroitin sulfate 1200 mg once/d, PO for adults of nl wt Notes/SE: Abd pain, anorexia, constipation or D, drowsiness, HA, heartburn, N/V, rash Interactions: ↑ Effects OF hypoglycemics Labs: Monitor serum glucose levels in diabetics NIPE: Take w/ food to reduce GI effects; no uniform standardization of herb Green Tea (Camellia sinensis) Uses: Antioxidant, antibacterial, diuretic; prevention of CA, hyperlipidemia, atherosclerosis, dental caries Actions: Chemical components include anti-inflammatory, anti-CA, polyphenol, epigallocatechin, & epigallocatechin-3-gallate which inhibit tumor growth; fluoride & tannins demonstrate antimicrobial action against oral bacteria; antioxidant activity delays lipid peroxidation; antimicrobial action due to inhibition of growth of various bacteria including S. aureus Available forms: Recommend 300–400 mg polyphenol PO OD (3 cups tea = 240–320 mg polyphenol) Contra: Caution ↑ intake may cause tannin-induced asthma Notes/SE: Tachycardia, insomnia, anxiety, N/V, ↑ BP Interactions: ↑ Effects OF doxorubicin, ephedrine, stimulant drugs, theophylline; ↑ risk of hypertensive crisis W/ MAOIs; ↑ bleeding risk W/ anticoagulants, antiplts; ↓ effects W/ antacids, dairy products Labs: ↑ PT, PTT NIPE: Con- tains caffeine—caution in PRG, infants, and small children & pts W/ CAD, hyperthyroidism & anxiety disorders; GI distress d/t tannins ↓ W/ the addition of milk; ↑ tannin content W/ ↑ brewing times Guarana (Paullinia cupana) Uses: Appetite suppressant, CNS stimulant, ↑ sexual performance, ↓ fatigue Actions: ↑ Caffine content stiulates cardiac, CNS, & smooth muscle; ↑ diuresis; ↓ plt aggregation Available forms: Daily divided doses w/ max 3 g PO daily Contra: Avoid in PRG & lactation, CAD, hyperthyroidism, anxiety disorders d/t high caffine content Notes/SE: Insomnia, tachycardia, anxiety, N/V, HA, HTN, Sz Interactions: ↑ Effects OF anticoagulants, antiplts, β-blockers, bronchodilators; ↑ risk of hypertensive crisis W/ MAOIs; ↑ effects W/ cimetidine, ciprofloxacin, ephedrine, hormonal contraceptives, theophylline, cola, coffee; ↓ effects OF adenosine, antihypertensives, benzodiazepines, Fe, ↓ effects W/ smoking Labs: ↑ PT, PTT NIPE: Tincs contain EtOH; may exacerbate GI disorders & HTN 304 Hawthorn

Hawthorn (Crataegus laevigata) Uses: Rx of HTN, arrhythmias, HF, stable angina pectoris, insomnia Action: ↑ Myocardial contraction by ↓ oxygen consumption, ↓ peripheral resistance, dilating coronary blood vessels, ACE inhibition Available forms: Tinc 1–2 mL (1:5 ratio) tid, PO; Liq ext 0.5–1 mL, (1:1 ration) tid, PO Notes/SE: Arrhythmias, fatigue, hypotension, N/V, sedation Inter- actions: ↑ Effects OF antihypertensives, cardiac glycosides, CNS depressants, & herbs such as adonis, lily of the valley, squill ↓; effects OF Fe Labs: False ↑ of digoxin NIPE: N PRG & lactation; many tincs contain EtOH Horsetail (Equisetum arvense) Uses: ↑ Strength of bones, hair, nails, & teeth; diuretic, treat dyspepsia, gout; topically used to treat wounds Actions: Multiple chemical components; flavonoids ↑ diuretic activity; contains silica which strengthens bones, hair, & nails Available forms: Extract 20–40 gtts in H2O N PO tid–qid; topically 10 g herb/L H2O as compress PRN Contra: PRG, lactation, w/ children, CAD; contains nicotine & large amts may cause nicotine tox Notes/SE: Nicotine tox (N/V, weakness, fever, dizziness, abnormal heart rate, wt loss) Interactions: ↑ Effects OF digoxin, diuretics, lithium, adonis, lily of the valley; ↑ CNS stimulation W/ CNS stimulants, theophylline, coffee, tea, cola, nicotine; ↑ K+ depletion W/ corticosteroids, diuretics, stimulant laxatives, licorice; ↑ risk of thiamine deficiency W/ EtOH use Labs: Monitor digoxin, electrolyte, thiamine levels NIPE: Tinc contains EtOH which may cause disulfiram-like reaction if taken with benzodiazepines or metronidazole; short-term use only; active components of herb absorbed thru skin Kava Kava (Piper methysticum) Uses: ↓ Anxiety, stress, & restlessness; sedative effect Action: Appears to act directly on the limbic system Available forms: Standardized ext (70% kavalactones) 100 mg bid–tid, PO Notes/SE: ↑ Re- flexes, HA, dizziness, visual changes, hematuria, SOB Interactions: ↑ Effects OF antiplts, benzodiazepines, CNS depressants, MAOIs, phenobarbital; ↑ absorption when taken W/ food; ↑ in parkinsonian symptoms W/ kava kava & antiparkinsonian drugs Labs: ↑ ALT, AST, urinary RBCs; ↓ albumin, total protein, bilirubin, urea, plts, lymphocytes NIPE: N Take for >3 mo; N during PRG & lactation Licorice (Glycyrrhiza glabra) Uses: Expectorant, shampoo, GI complaints Action: ↑ Mucus secretions, ↓ peptic activity, ↓ scalp sebum secretion Available forms: Liq ext, bulk dried root, tea; 15 g once/d PO of licorice root; intake >50 g once/d may cause tox Notes/SE: HTN, arrhythmias, edema, hypokalemia, HA, lethargy, rhabdomyolysis Interactions: ↑ Drug effects OF diuretics, corticosteroids, may prolong QT interval W/ loratadine, procainamide, quinidine, terfenadine Labs: None NIPE: Monitor for electrolyte & ECG changes, HTN, mineralocorticoid-like effects; tox more likely w/ prolonged intake of small doses than one large dose Melatonin (MEL) Uses: Insomnia, jet lag, antioxidant, immunostimulant Action: Hormone produce by the pineal gland in response to darkness; declines w/ age Available forms: XR caps 1–3 mg once/d 2 h before hs PO Notes/SE: HA, Saw Palmetto 305 confusion, sedation, HTN, tachycardia, hyperglycemia Interactions: ↑ Anxiolytic effects OF benzodiazepines; ↑ risk of insomnia W/ cerebral stimulants, metham- phetamine, succinylcholine Labs: None NIPE: N During PRG & lactation Milk Thistle (Silybum marianum) Uses: Rx of hepatotox, dyspepsia, liver protectorant Action: stimulates protein synthesis, which leads to liver cell regeneration Available forms: Tinc 70–120 mg (70% silymarin) tid, PO Notes/SE: D, menstrual stimulation, N/V Interactions: ↑ Effects OF drugs metabolized by the cytochrome P-450, CYP3A4, CYP2C9 enzymes Labs: ↑ PT; ↓ LFTs, serum glucose NIPE: N PRG & lactation; N pts allergic to ragweed, chrysanthemums, marigolds, daisies Nettle (Urtica dioica) Uses: Allergic rhinitis, asthma, cough, TB, BPH, bladder inflammation, diuretic, antispasmodic, expectorant, astringent and topically for oily skin, dandruff, & hair stimulant Actions: Multiple chemical components have different actions; scopoletin has anti-inflammatory action, root extract ↓ BPH, lectins display immunostimulant action Available forms: Caps 150–300 mg PO OD; Liq extract 2–8 mL PO tid Contra: N PRG or lactating or in children <2 y Notes/SE: N/V, edema, abd distress, diarrhea, oliguria, edema, local skin irritation Interactions: ↑ Effects OF diclofenac, diuretics, barbiturates, antipsychotics, opiates, EtOH; ↓ effects OF anticoagulants Labs: Monitor electrolytes NIPE: Skin contact w/ plant will result in stinging & burning; ↑ intake of foods high in K+ Rue (Ruta graveolens) Uses: Sedative, spasmolytic for muscle cramps, GI & menstrual disorders, promote lactation, promote abortion via uterine stimulation, anti-inflammatory effect for sports injuries, bruising, arthritis, joint pain Ac- tion: Contains essential oils, flavonoids, & alkaloids; shown mutagenic & cytotoxic action on cells; produced CV effects due to + chronotropic & inotropic effects on atria; vasodilatory effects reduce BP; shown strengthening effect on cap- illaries; alkaloids produce antispasmodic & abortifacient activity Available forms: Caps, extracts, teas, topical creams, topical oils; topical oil for earache; topical creams to affected areas PRN; teas use 1 tsp/1/4 L H2O; extract 1/4–1 tsp PO tid with food; caps 1 PO tid with food Notes/SE: Dizziness, tremors, hypotension, bradycardia, allergic skin reactions, spontaneous abortion Contra: N During PRG or lactation or give to children; caution in pts with CHF, arrhythmias, or receiving antihypertensive medication Interactions: ↑ Inotropic effects OF cardiac glycosides; ↑ effects OF antihypertensives & warfarin; ↓ effects OF fertility drugs Labs: ↑ BUN, Cr, LFT NIPE: Large doses can be toxic or fatal; research does not establish a safe dose; tincs & extracts contain EtOH; no data with use in children; N if h/o EtOH abuse or liver disease Saw Palmetto (Serenoa repens) Uses: Rx of benign prostatic hyper- trophy (BPH) stages 1 & 2 (inhibits testosterone-5-α-reductase), ↑ sperm production, ↑ breast size (estrogenic), ↑ sexual vigor, mild diuretic, treat chronic cystitis Action: Theorized that sitosterols inhibit conversion of testosterone to dihydrotestosterone 306 Spirulina

(DHT), which reduces the prostate gland, also competes w/ DHT on receptor sites resulting in antiestrogenic effects Available forms: Caps/tabs 160 mg bid, PO; tinc 20–30 gtt qid (1:2 ration); fluid ext, standardized 160 mg bid PO or 320 mg once/d PO Notes/SE: Abd pain, back pain, D, dysuria, HA, HTN, N/V, impotence Con- tra: N PRG, lactation Interactions: ↑ Effects OF adrenergics, anticoagulants, antiplts, hormones, Fe Labs: May affect semen analysis, may cause false - PSA NIPE: Take w/ meals to ↓ GI upset, do baseline PSA prior to taking herb, no standardization of herb content Spirulina (Spirulina spp) Uses: Rx of obesity & as a nutritional supplement Action: Contains 65% protein, all amino acids, carotenoids, B-complex vitamins, essential fatty acids & Fe; has been shown to inhibit replicating viral cells Available forms: Caps/tabs or powder admin 3–5 g ac, PO Notes/SE: Anorexia, N/V Interactions: ↑ Effects OF anticoagulants; ↓ effects OF thyroid hormones ↓ ↑ due to high iodine content; absorption OF vitamin B12 Labs: Serum Ca, alkaline phosphatase; monitor PT, INR NIPE: May contain ↑ levels of Hg & radioactive ion content Stevia (Stevia rebaudiana) Uses: Natural sweetener, hypoglycemic and hypotensive properties Actions: Multiple chemical components; sweetness d/t glycoside stevioside; hypotensive effect may be d/t diuretic action or vasodilation action Available forms: Liq extract, powder, caps Notes/SE: HA, dizziness, bloating Interactions: ↑ Hypotensive effects W/ antihypertensives esp CCB, diuretics Labs: Monitor BS NIPE: Monitor BP; does not encourage dental caries St. John’s Wort (Hypericum perforatum) Uses: Depression, anxiety, anti-inflammatory, antiviral Action: MAOI in vitro, not in vivo; bacteriostatic & bactericidal, ↑ capillary blood flow, uterotonic activity in animals Available forms: Teas, tabs, caps, tinc, oil ext for topical use Notes/SE: Photosensitivity (use sunscreen) rash, dizziness, dry mouth, GI distress Interactions: Enhance MAOI activity, EtOH, narcotics, sympathomimetics Labs: ↑ GH; ↓ digoxin, serum iron, serum prolactin, theophylline NIPE: N PRG, breast-feeding, or in children, N w/ SSRIs, MAOIs, EtOH, N sun exposure Tea Tree (Melaleuca alternifolia) Uses: Rx of superficial wounds (bacterial, viral,& fungal, insect bites, minor burns, cold sores, acne Action: Broad-spectrum antibiotic activity against E. coli, S. aureus, C. albicans Available forms: Topical creams, lotions, oint, oil apply topically PRN Notes/SE: Ataxia, contact dermatitis, D, drowsiness, GI mucosal irritation Interactions: ↓ Effects OF drugs that affect histamine release Labs: ↑ Neutrophil count NIPE: Caution pt to use externally only; N apply to broken skin Valerian (Valeriana officinalis) Uses: Antianxiety, antispasmodic, dysmenorrheal, restlessness, sedative Action: Inhibits uptake & stimulates release of GABA, which ↑ GABA concentration extracellularly & causes sedation Avail- able forms: Ext 400–900 mg PO 30 min < HS, tea 2–3 g (1 tsp of crude herb) qid, Valerian 307

PRN, tinc 3–5 mL (1/2–1 tsp) (1:5 ratio) PO qid, PRN Notes/SE: GI upset, HA, insomnia, N/V, palpitations, restlessness, vision changes Interactions: ↑ Effects OF barbiturates, benzodiazepines, opiates, EtOH, catnip, hops, kava kava, passion flower, skullcap; ↓ effects OF MAOIs, phenytoin, warfarin Labs: ↑ ALT, AST, total bilirubin, urine bilirubin NIPE: Periodic check of LFTs, unknown effects in PRG & lactation, full effect may take 2–4 wk, taper herb to avoid withdrawal symptoms after long-term use

Unsafe Herbs with Known Toxicity

Agent Toxicities

Aconite Salivation, N/V, blurred vision, cardiac arrhythmias Aristolochic acid Nephrotox Calamus Possible carcinogenicity Chaparral Hepatotox, possible carcinogenicity, nephrotox “Chinese herbal May contain MaHuang or other dangerous mixtures” herbs Coltsfoot Hepatotox, possibly carcinogenic Comfrey Hepatotox, carcinogenic Ephedra/MaHuang Adverse cardiac events, stroke, Sz Juniper High allergy potential, D, Sz, nephrotox Kava kava Hepatotox Licorice Chronic daily amounts (>30 g/mo) can result in ↓ K+, Na/fluid retention w/HTN, myoglobinuria, hyporeflexia Life root Hepatotox, liver cancer MaHuang/Ephedra Adverse cardiac events, stroke, Sz Pokeweed GI cramping, N/D/V, labored breathing, ↓ BP, Sz Sassafras V, stupor, hallucinations, dermatitis, abortion, hypothermia, liver cancer Usnic acid Hepatotox Yohimbine Hypotension, abdominal distress, CNS stimulation (mania/& psychosis in predisposed individuals) 308 Yohimbine

Yohimbine (Pausinystalia yohimbe) Uses: Rx for impotence, aphrodisiac Action: Peripherally affects autonomic nervous system by ↓ adrenergic activity & ↑ cholinergic activity; ↑ blood flow Available forms: Tabs 5.4 mg tid, PO; doses at 20–30 mg/d may ↑ BP & heart rate Notes/SE: Anxiety, dizziness, dysuria, genital pain, HTN, tachycardia, tremors Interactions: ↑ Effects OF CNS stimulants, MAOIs, SSRIs, caffeine, EtOH; ↑ risk of tox W/ α-adrenergic blockers, phenothiazines; ↑ yohimbe tox W/ sympathomimetics; ↑ BP W/ foods containing tyramine Labs: ↑ BUN, Cr NIPE: N w/ caffeine-containing foods w/ herb, may exacerbate mania in patients w/ psychiatric disorders Tables

309 Copyright © 2009 by Judith A. Barberio. Click here for terms of use. b Extra b Regular a Junior Strength Strength a tsp tsp tsp Liquid and 160-mg 325-mg 500-mg a 2 tab 1 tsp 3 tab 1 a c c c c dppr (0.4 mL) (0.8 mL) (1.2 mL) dppr Suspension 1 dppr 1 Original Drops Chewable Dropperful mg tabs 160 mg/5 mL Chewables Tablets Gelcaps 80 mg/0.8 mL 80- Tablets Original Elixir Caplets/ Caplets/ Caplets/ Drops and Suspension 6–11 lb/ 2.5–5.4 kg 12–17 lb/ 5.5–7.9 kg 18–23 lb/ 8.0–10.9 kg 11.0–15.9 kg (1.6 mL) 16.0–21.9 kg TABLE 1 TABLE Line Product Quick Guide to Dosing of Acetaminophen Based on the Tylenol 4–11 mo/ 12–23 mo/ 2–3 y/24–35 lb/ 2 dppr Birth–3 mo/ 4–5 y/36–47 lb/

310 gel tabs cap/tab 2 cap/tab 2 3 cap/tab 4 cap/tab 1 or 2 caps/ 2 caps/ tsp 4 tab 2 tsp 6 tab 4 tsp 5 tab 2 44.0 kg 12 y 96 lb = 22.0–26.9 kg 27.0–31.9 kg 32.0–43.9 kg = = Doses should be administered 4 or 5 times daily. Do not exceed 5 doses in 24 h. Doses should be administered 4 or 5 times daily. unless directed by a physician. No more than 8 dosage units in any 24-h period. Not to be taken for pain 10 days or fever 3 Dropperful. 6–8 y/48–59 lb/ a b c 9–10 y/60–71 lb/ 11 y/72–95 lb/ Adults & children

311 a Volume in Volume Maximum Dose 4 28 mL of 1% solution Onset Duration5–30 min mg/kg 2–3 h 70-kg Adult 7 50 mL of 1% solution Anestacon Proprietary Names Marcaine Xylocaine, 7–30 min 5–30 min 5–7 h 2 h Novocaine 3 Rapid 70 mL of 0.25% solution 30 min–1 h 10–15 70–105 mL of 1% solution with epinephrine (1:200,000) To calculate the maximum dose if not a 70-kg adult, use fact that 1% solution has 10 mg of drug per milliliter. To TABLE 2 TABLE Local Anesthetic Comparison Chart for Commonly Used Injectable Agents Agent Bupivacaine Procaine a Lidocaine Lidocaine Mepivacaine Carbocaine 5–30 min 2–3 h 7 50 mL of 1% solution

312 Tables 313

TABLE 3 Comparison of Systemic Steroids

Relative Mineralo- Equivalent corticoid Duration Drug Dose (mg) Activity (h) Route

Betamethasone 0.75 0 36–72 PO, IM Cortisone 25 2 8–12 PO, IM (Cortone) Dexamethasone 0.75 0 36–72 PO, IV (Decadron) Hydrocortisone 20 2 8–12 PO, IM, (Solu-Cortef, IV Hydrocortone) Methylprednisolone 4 0 36–72 PO, IM, acetate IV (Depo-Medrol) Methylprednisolone 4 0 8–12 PO, IM, succinate IV (Solu-Medrol) Prednisone 5 1 12–36 PO (Deltasone) Prednisolone 5 1 12–36 PO, IM, (Delta-Cortef) IV bid–qid qd/bid bid–qid qd/bid bid/tid bid/tid Apply bid/tid Low Intermediate bid/tid High Low Ultrahigh bid/qid Ultrahigh qd/bid Intermediate High Ultrahigh bid (2 wk max) Intermediate qd–qid Intermediate qd/bid Low Low Potency 0.05% scalp, soln 0.05% oint, lotion 0.1% Topicort cream, oint Topicort Aeroseb-Dex aerosol 0.01% Decadron cream 0.1% Psorcon cream, oint 0.05% Diprolene oint, gel Topicort LP cream, gel 0.05% Topicort Diprosone aerosol 0.1% Diprosone cream 0.05% cream, gel, oint, Temovate Cloderm cream 0.1% DesOwen, cream, oint, lotion 0.05% Low Valisone cream 0.01, 0.1%, Valisone Valisone cream, lotion 0.01% Valisone Aclovate, cream, oint 0.05% Cyclocort, cream, lotion, oint 0.1% High Common Trade Names Common Trade onate onate, augmented Fluocinolone acetonide 0.025% Synalar oint, cream 0.025% Diflorasone diacetate Fluocinolone acetonide 0.01% Synalar cream, soln 0.01% Desoximetasone 0.25% Betamethasone dipropi- Desoximetasone 0.05% Betamethasone dipropi- Betamethasone valerate Betamethasone valerate Dexamethasone base Fluocinolone Clobetasol propionate Clocortolone pivalate Desonide Desoximetasone Aclometasone dipropionate Amcinonide Betamethasone TABLE 4 TABLE Preparations Steroid Topical Agent

314 )

Continued ( tid/qid bid/tid bid/tid oint tid/qid Intermediate bid/tid High Intermediate bid/tid High Intermediate qd IntermediateIntermediate bid/tid bid/tid 2 etc. 0.1% cream, oint, sol soln 0.05% cream, lotion, oint 0.05% tape, 4 mcg/cm aerosol 1%, cream 0.5, 1, 2.5%, gel 0.5%, oint 0.5, 1, 2.5%, lotion 0.5, 1, 2.5%, paste 0.5%, soln 1% Corticaine cream, oint 0.5, 1% Low Cutivate cream 0.05%, oint 0.005%Ultravate cream, oint 0.05%Halog cream 0.025%, emollient base Intermediate High bid Cortizone, Caldecort, Hycort, Hytone, high Very Low qd/tid bid Lidex, anhydrous cream, gel, Lidex-E aqueous cream 0.05% Cordran cream, oint 0.025% Hydrocortisone acetate Hydrocortisone butyrate Locoid oint, soln 0.1% Hydrocortisone Fluocinolone acetonide 0.2% cream 0.2% Synalar-HP Hydrocortisone valerate cream, oint 0.2% Westcort Fluocinonide 0.05% Hydrocortisone Fluticasone propionate Halobetasol Halcinonide Flurandrenolide

315 tid/qid tid/qid Apply Intermediate tid/qid Low Intermediate bid High Potency oint, lotion 0.025% oint, lotion 0.1% oint 0.5% Common Trade Names Common Trade Aerosol 0.2-mg/2-sec spray Elocon 0.1% cream, oint, lotionDermatop 0.1% cream Intermediate qd 0.025% 0.1% 0.5% Triamcinolone acetonide Triamcinolone Aristocort, Kenalog cream, Triamcinolone acetonide Triamcinolone Aristocort, Kenalog cream, Triamcinolone acetonide Triamcinolone Aristocort, Kenalog cream, TABLE 4 (Continued) TABLE Preparations Steroid Topical Agent Mometasone furoate Prednicarbate Triamcinolone

316 317 Tables

TABLE 5 Comparison of Insulins

Onset Peak Duration Type of Insulin (h) (h) (h)

Ultra Rapid

Apidra (glulisine) Immediate 0.5–1.5 3–5 Humalog (lispro) Immediate 0.5–1.5 3–5 NovoLog (insulin aspart) Immediate 0.5–1.5 3–5

Rapid

Regular Iletin II 0.25–0.5 2–4 5–7 Humulin R 0.5 2–4 6–8 Novolin R 0.5 2.5–5 5–8 Velosulin 0.5 2–5 6–8

Intermediate

NPH Iletin II 1–2 6–12 18–24 Lente Iletin II 1–2 6–12 18–24 Humulin N 1–2 6–12 14–24 Novulin L 2.5–5 7–15 18–24 Novulin 70/30 0.5 7–12 24

Prolonged

Ultralente 4–6 14–24 28–36 Humulin U 4–6 8–20 24–28 Lantus (insulin glargine) 4–6 No peak 24

Combination Insulins

Humalog Mix 0.25–0.5 1–4 24 (lispro protamine/ lispro) ) a Iron Progestin (mg) Ethinyl estradiol (20)Ethinyl estradiol (20)Ethinyl estradiol (35)Ethinyl estradiol (30) Levonorgestrel (0.1) Levonorgestrel (0.1) Ethinyl estradiol (30) Norethindrone (0.5) Norgestrel (0.3) Desogestrel (0.15) Ethinyl estradiol (20, 30, 35) Norethindrone acetate (1) Ethinyl estradiol (30) Desogestrel (0.15) Estrogen (mcg) b (Warner-Chilcott) (Warner-Chilcott) Alesse 21, 28 (Wyeth) Apri 28 (Barr) 28 (Barr) Aviane Brevicon 28 (Watson) Cryselle 28 (Barr) Demulen 1/35 21, 28 (Pfizer)Demulen 1/50 21, 28 (Pfizer) Ethinyl estradiol (35)Desogen 28 (Organon) Ethinyl estradiol (50)Estrostep 28 (Warner-Chilcott) Ethynodiol diacetate (1) Ethynodiol diacetate (1) TABLE 6 TABLE Commonly Used Oral Contraceptives (21 = 21 Active Pills; 28 Pills + 7 Placebo Drug (Manufacturer) Monophasics FemconFe (Warnen-Chilcott)Junel Fe 1/20, 21, 28 (Barr)Junel Fe 1.5/30 21, 28 (Barr) Ethinyl estradiol (35)Kariva 28 (Barr) Ethinyl estradiol (20) Ethinyl estradiol (30)Lessina 28 (Barr)Levlen 21, 28 (Berlex)Levlite 28 (Berlex) Norethindrone (0.4)Levora 28 (Watson) Norethindrone acetate (1)Loestrin Fe 1.5/30 21, 28 Norethindrone acetate (1.5) 7 in 28 days 7 in 28 days Loestrin Fe 1/20 21, 28 Ethinyl estradiol (30) Ethinyl estradiol (20, 0, 10) Ethinyl estradiol (20) Ethinyl estradiol (30) 75 mg FE Desogestrel (0.15) Ethinyl estradiol (20) Ethinyl estradiol (30) Ethinyl estradiol (20) Levonorgestrel (0.15) Levonorgestrel (0.1) Norethindrone acetate (1.5) 7 in 28 days Levonorgestrel (0.1) Levonorgestrel (0.15) Norethindrone acetate (1) 7 in 28 days 318 )

Continued ( (Watson) (Watson) (Ortho-McNeil) (Ortho-McNeil) Lo/Ovral 21, 28 (Wyeth)Low-Ogestrel 28 (Watson)Microgestin Fe 1/20 21, 28 Ethinyl estradiol (30)Microgestin Fe 1.5/30 21, 28 Ethinyl estradiol (20) Ethinyl estradiol (30) Ethinyl estradiol (30)Mircette 28 (Organon)Modicon 28 (Ortho-McNeil) Norgestrel (0.3) MonoNessa 28 (Watson) Norethindrone acetate (1) Norgestrel (0.3) Necon 1/50 28 (Watson) Norethindrone acetate (1.5) Ethinyl estradiol (35)Necon 0.5/35, 28 (Watson) 7 in 28 days Ethinyl estradiol (20, 0, 10) 7 in 28 days Necon 1/35 28 (Watson) Ethinyl estradiol (35)Nordette 21, 28 (King) Desogestrel (0.15) Ethinyl estradiol (35) Mestranol (50)Nortrel 0.5/35 28 (Barr) Norethindrone (0.5) Nortrel 1/35 21, 28 (Barr) Ethinyl estradiol (35)Norinyl 1/35 28 (Watson) Norgestimate (0.25) Norinyl 1/50 28 (Watson) Ethinyl estradiol (30) Norethindrone (0.5) Ethinyl estradiol (35)Ogestrel 28 (Watson) Ethinyl estradiol (35)Ortho-Cept 28 (Ortho-McNeil) Ethinyl estradiol (35) Norethindrone (1) Norethindrone (1) Ortho-Cyclen 28 (Ortho-McNeil) Mestranol (50) Ethinyl estradiol (30)Ortho-Novum 1/35 28 Ethinyl estradiol (35) Levonorgestrel (0.15) Norethindrone (0.5) Norethindrone (1) Ortho-Novum 1/50 28 Ethinyl estradiol (50) Norethindrone (1) Desogestrel (0.15) Ethinyl estradiol (35) Norgestimate (0.25) Norethindrone (1) Mestranol (50) Norgestrel (0.5) Norethindrone (1) Norethindrone (1)

319 ) a Iron Progestin (mg) Progestin (mg) 40, 30) Ethinyl estradiol (30) Drospirenone (3) Ethinyl estradiol (25) Desogestrel (0.1, 0.125, 0.15) Ethinyl estradiol (35)Ethinyl estradiol (25) Norethindrone (0.5, 0.75, 1.0) Norgestimate (0.18, 0.215, 0.25) Ethinyl estradiol (35) Norethindrone (0.4) Ethinyl estradiol (30)Ethinyl estradiol (35) Levonorgestrel (0.15) Norgestimate (0.25) Ethinyl estradiol (30, Levonorgestrel (0.05, 0.075, 0.125) Ethinyl estradiol (35) Norethindrone (0.5, 0.75, 1.0) Estrogen (mcg) Estrogen (mcg) b (Warner-Chilcott) (Ortho-McNeil) Ovcon 35 21, 28 Sprintec 28 (Barr) 28 (Berlex) Yasmin Zovia 1/50E 28 (Watson)Zovia 1/35E 28 (Watson) Ethinyl estradiol (50) Ethinyl estradiol (35) Ethynodiol diacetate (1.0) Cyclessa 28 (Organon) Ethynodiol diacetate (1.0) Enpresse 28 (Barr) Necon 10/11 21, 28 (Watson)Necon 7/7/7 (Watson) Ethinyl estradiol (35)Nortrel 7/7/7 28 (Barr) 21, 28 Ortho Tri-Cyclen Norethindrone (0.5, 1.0) Ovcon 50 28 (Warner-Chilcott)Ovral 21, 28 (Wyeth-Ayerst) Ethinyl estradiol (50)Portia 28 (Barr) Ethinyl estradiol (50) Norethindrone (1) Norgestrel (0.5) TABLE 6 (Continued) TABLE Commonly Used Oral Contraceptives (21 = 21 Active Pills; 28 Pills + 7 Placebo Monophasics Drug (Manufacturer) Multiphasics Drug

320 Norethindrone (0.35) Norethindrone (0.35) Norgestrel (0.075) Norethindrone (0.35) Norethindrone (0.35) Norethindrone (0.35) Norethindrone (0.35) 35, 35) 35, 35) 40, 30) None None Ethinyl estradiol (25)None Desogestrel (0.1, 0.125, 0.15) Estrogen (mcg) Progestin (mg) 35, 35) 40, 30) Ethinyl estradiol (35)40, 30) Norgestimate (0.18, 0.215, 0.25) (Ortho-McNeil) (Ortho-McNeil) (Ortho-McNeil) Nora-BE 28 (Ortho-McNeil)Ovrette (Wyeth-Ayerst) None None Errin (Barr) Jolivette 28 (Watson)Micronor (Ortho-McNeil) (Watson) Nor-QD None None Ortho Tri-Cyclen lo 21, 28 Ortho Tri-Cyclen Ethinyl estradiol (35, Norgestimate (0.18, 0.215, 0.25) Drug Ortho-Novum 10/11 21 Ethinyl estradiol (35, 35)Ortho-Novum 7/7/7 21 Norethindrone (0.5, 1.0) Ethinyl estradiol (35, Only Progestin Norethindrone (0.5, 0.75, 1.0) 28 (Berlex)Tri-Levlen 28 (Watson)Tri-Nessa 21, 28 (Watson)Tri-Norinyl Ethinyl estradiol (30, Ethinyl estradiol (35, 21, 28 (Wyeth)Triphasil Ethinyl estradiol (35) Levonorgestrel (0.05, 0.075, 0.125) Norethindrone (0.5, 1.0, 0.5) (Barr) Tri-Sprintec Norgestimate (0.18, 0.215, 0.25) Ethinyl estradiol (30, (Watson)Trivora-28 Levonorgestrel (0.05, 0.075, 0.125) (Barr) Velivet Camila (Barr) Ethinyl estradiol (30, Levonorgestrel (0.05, 0.075, 0.125)

321 ) a Additional Pills estradiol Progestin (mcg) Estrogen (mg) Ethinyl estradiol (20) Drospirenone 4 (3) Ethinyl estradiol (30) Levonorgestrel (0.15) Inert 10 mcg ethinyl Ethinyl estradiol (30) Levonorgestrel (0.15) Inert Volume 2 (Issue 24) August 2004, Volume 29 (Issue 1266) 2007. 2 (Issue 24) August 2004, Volume Volume

Medical Letter b 91-day pack 91-day pack 28 day pack The designations 21 and 28 refer to number of days in regimen available. Also approved for acne. TABLE 6 (Continued) TABLE Commonly Used Oral Contraceptives (21 = 21 Active Pills; 28 Pills + 7 Placebo Drug Based in part on data published in the a b Lybrel (Wyeth) 28 day packLybrel (Berlex) 28 day pack Yaz Ethinyl estradiol (20) Levonorgestrel (0.09) None Loestrin 24 Fe (Warner Chilcott) Loestrin 24 Fe (Warner Seasonique 7 (Duramed) Ethinyl estradiol (20) Norethindrone 4 (1) Inert Extended-Cycle Combination Seasonale 7 (Duramed)

322 Tables 323

TABLE 7 Some Common Oral Potassium Supplements

mEq Potassium/ Brand Name Salt Form Dosing Unit

Glu-K Gluconate Tablet 2 mEq/tablet Kaochlor 10% KCl Liquid 20 mEq/15 mL Kaochlor S-F 10% KCl Liquid 20 mEq/15 mL (sugar-free) Kaochlor Eff Bicarbonate/ Effervescent 20 mEq/tablet KCl/citrate tablet Kaon elixir Gluconate Liquid 20 mEq/15 mL Kaon Gluconate Tablet 5 mEq/tablet Kaon-Cl KCl Tablet, SR 6.67 mEq/tablet Kaon-Cl 20% KCl Liquid 40 mEq/15 mL KayCiel KCl Liquid 20 mEq/15 mL K-Lor KCl Powder 15 or 20 mEq/packet Klorvess Bicarbonate/ Liquid 20 mEq/15 mL KCl Klotrix KCl Tablet, SR 10 mEq/tablet K-Lyte Bicarbonate/ Effervescent 25 mEq/tablet citrate tablet K-Tab KCl Tablet, SR 10 mEq/tablet Micro-K KCl Capsule, 8 mEq/capsule SR Slow-K KCl Tablet, SR 8 mEq/tablet Tri-K Acetate/bicar- Liquid 45 mEq/15 mL bonate and citrate Twin-K Citrate/gluconate Liquid 20 mEq/5 mL

SR = sustained release. 324 Tables

TABLE 8 Tetanus Prophylaxis

Clean, Minor All Other History of Absorbed Wounds Woundsa Tetanus Toxoid Immunization Tdb TIGc Tdd TIGc

Unknown or <3 doses Yes No Yes Yes =3 doses Noe No Nof No aSuch as, but not limited to, wounds contaminated with dirt, feces, soil, saliva, etc; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite. bTd = tetanus-diphtheria toxoid (adult type), 0.5 mL IM. • For children <7 y, DPT (DT, if pertussis vaccine is contraindicated) is preferred to tetanus toxoid alone. • For persons >7 y, Td is preferred to tetanus toxoid alone. • DT = diphtheria-tetanus toxoid (pediatric), used for those who cannot receive pertussis. cTIG = tetanus immune globulin, 250 U IM. dIf only 3 doses of fluid toxoid have been received, then a fourth dose of toxoid, preferably an adsorbed toxoid, should be given. eYes, if >10 y since last dose. fYes, if >5 y since last dose. Source: Based on guidelines from the Centers for Disease Control and Prevention and reported in MMWR. Tables 325

TABLE 9 Oral Anticoagulant Standards of Practice

Thromboembolic Disorder INR Duration

Deep Venous Thrombosis & Pulmonary Embolism Treatment single episode Transient risk factor 2–3 3 mo Idiopathic 2–3 6–12 mo Recurrent systemic embolism 2–3 Indefinite Prevention of Systemic Embolism Atrial fibrillation (AF)a 2–3 Indefinite AF: cardioversion 2–3 3 wk prior; 4 wk post sinus rhythm Valvular heart disease 2–3 Indefinite Cardiomyopathy 2–3 Indefinite Acute Myocardial Infarction High-risk patientsc 2–3 + low dose aspirin Prosthetic Valves Tissue heart valves 2–3 3 mo Bileaflet mechanical valves 2–3 Indefinite in aortic position Other mechanical prosthetic valvesb 2.5–3.5 Indefinite aWith high-risk factors or multiple moderate risk factors. bMay add aspirin 81 mg to warfarin in patients with caged ball or caged disks valves with additional risk factors. cLarge anterior MI, significant heart failure, intracardiac thrombus, and/or history of thromboembolic event. INR = international normalized ratio. Source: Based on data published in Chest 2004 Sep; 126 (Suppl): 16. 326 Tables

TABLE 10 Antiarrhythmics: Vaughn Williams Classification

Class I: Sodium Channel Blockade A. Class Ia: Lengthens duration of action potential (↑ the refractory period in atrial and ventricular muscle, in SA and AV conduction systems, and Purkinje fibers) 1. Amiodarone (also class II, III, IV) 2. Disopyramide (Norpace) 3. Imipramine (MAO inhibitor) 4. Procainamide (Pronestyl) 5. Quinidine B. Class Ib: No effect on action potential 1. Lidocaine (Xylocaine) 2. Mexiletine (Mexitil) 3. Phenytoin (Dilantin) 4. Tocainide (Tonocard) C. Class Ic: Greater sodium current depression (blocks the fast inward Na+ current in heart muscle and Purkinje fibers, and slows the rate of ↑ of phase 0 of the action potential) 1. Flecainide (Tambocor) 2. Propafenone Class II: Beta Blocker D. Amiodarone (also class Ia, III, IV) E. Esmolol (Brevibloc) F. Sotalol (also class III) Class III: Prolong Refractory Period via Action Potential G. Amiodarone (also class Ia, II, IV) H. Sotalol Class IV: Calcium Channel Blocker I. Amiodarone (also class Ia, II, III) J. Diltiazem (Cardizem) K. Verapamil (Calan) Tables 327

TABLE 11 Cytochrome P-450 Isoenzymes and the Drugs They Metabolize, Inhibit, and Inducea

CYP1A2 Substrates: Acetaminophen, caffeine, clozapine, imipramine, theophylline, propranolol Inhibitors: Most fluoroquinolone antibiotics, fluvoxamine, cimetidine Inducer: Tobacco smoking, charcoal-broiled foods, cruciferous veg- etables, omeprazole

CYP2C9 Substrates: Most NSAIDs (including COX-2), warfarin, phenytoin Inhibitors: Fluconazole Inducer: Barbiturates, rifampin

CYP2C19 Substrates: Diazepam, lansoprazole, omeprazole, phenytoin, pantoprazole Inhibitors: Omeprazole, isoniazid, ketoconazole Inducer: Barbiturates, rifampin

CYP2D6 Substrates: Most ␤-blockers, codeine, clomipramine, clozapine, codeine, encainide, flecainide, fluoxetine, haloperidol, hydrocodone, 4-methoxy-amphetamine, metoprolol, mexiletine, oxycodone, paroxetine, propafenone, propoxyphene, risperidone, selegiline (deprenyl), thioridazine, most tricyclic antidepressants, timolol Inhibitors: Fluoxetine, haloperidol, paroxetine, quinidine Inducer: Unknown

CYP3A Substrates: Anticholinergics: Darifenacin, oxybutynin, solifenacin, tolterodine Benzodiazepines: Alprazolam, midazolam, triazolam Ca channel blockers: Diltiazem, felodipine, nimodipine, nifedipine, nisoldipine, verapamil

(Continued) 328 Tables

TABLE 11 (Continued) Cytochrome P-450 Isoenzymes and the Drugs They Metabolize, Inhibit, and Inducea

Chemotherapy: Cyclophosphamide, erlotinib, ifosfamide, paclitaxel, tamoxifen, vinblastine, vincristine HIV protease inhibitors: Amprenavir, atazanavir, indinavir, nelfinavir, ritonavir, saquinavir HMG-CoA reductase inhibitors: Atorvastatin, lovastatin, simvastatin Immunosuppressive agents: Cyclosporine, tacrolimus Macrolide-type antibiotics: Clarithromycin, erythromycin, telithromycin, troleandomycin Opioids: Alfentanyl, cocaine, fentanyl, sufentanil Steroids: Budesonide, cortisol, 17-␤-estradiol, progesterone Others: Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Inhibitors: Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiazem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Inducer: Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John’s wort aIncreased or decreased (primarily hepatic cytochrome P-450) metabolism of medications may influence the effectiveness of drugs or result in significant drug–drug interactions. Understanding the common cytochrome P-450 isoforms (eg, CYP2C9, CYP2D9, CYP2C19, CYP3A4) and common drugs that are metabolized by (aka “substrates”), inhibit, or induce activity of the isoform helps minimize significant drug interactions. CYP3A is in- volved in the metabolism of >50% of drugs metabolized by the liver. Based on data from Katzung B (ed). Basic and Clinical Pharmacology, 9th ed. McGraw-Hill, New York, 2004; The Medical Letter, Volume 47, July 4, 2004; http://www.fda.gov/cder/drug/drugreactions (accessed Sep- tember 16, 2005). Tables 329

TABLE 12 SSRIs/SNRI/Triptan and Serotonin Syndrome

A life-threatening condition, when selective serotonin reuptake inhibitors (SSRIs) and 5-hydroxytryptamine receptor agonists (triptans) are used together. However, many other drugs have been implicated (see below). Signs and symptoms of serotonin syndrome include the following: Restlessness, coma, N/V/D, hallucinations, loss of coordination, overactive reflexes, ↑ heart rate/temperature, rapid changes in BP, increased body temperature

Class Drugs

Antidepressants MAOIs, TCAs, SSRIs, SNRIs, mirtazapine, venlafaxine CNS stimulants Amphetamines, phentermine, methylphenidate, sibutramine 5-HT1 agonists Triptans Illicit drugs Cocaine, methylenedioxymethamphetamine (ecstasy), lysergic acid diethylamide (LSD) Opioids Tramadol, pethidine, oxycodone, morphine, meperidine Others Buspirone, chlorpheniramine, dextromethorphan, linezolid, lithium, selegiline, tryptophan, St John’s wort Management includes removal of the precipitating drugs, and supportive care. To control agitation serotonin antagonists (cyproheptadine or methy- sergide) can be used. When symptoms are mild, discontinuation of the medication or medications, and the control of agitation with benzodiazepines may be needed. Critically ill patients may require sedation and mechanical ventilation as well as control of hyperthermia.

Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112–1120. 5 Biotin B 12 Folate B 6 B 3 B 2 B 1 Water Soluble Water ADEKCB Vitamins Fat Soluble TABLE 13 TABLE Element Composition of Selected Multivitamins and with Mineral Trace Supplements CentrumCentrum 70Performance 70 100Centrum 70 200Silver 100 31 100 100NatureMade 60 150 200 31Multi 13 100 300Complete 100 167 100NatureMade 100 300 31 100Multi Daily 60 200 100 200NatureMade 60 100 100 100 300Multi Max 100 100 100 100 100NatureMade 100 500 100 100 NA 150Multi-50+ 100 50 100 300 100 100 200 100One-A-Day 50 100 13 500 13 10050+ 100 417 100 3333 100One-A-Day 100 100 10 200 110 10 100 2941Essential 100 200 25 100 100 250 100 100 100 10 100 200 200 2500 NA 100 100 300 100 100 100 833 100 200 100 200 17 NA 100 100 100 300 100 417 500 100 100 100 10 100 417 100 10 100 NA 150 100

330 )

Continued ( One-A-Day 50Maximum 100Therapeutic 100 100Vitamin 100 31 100Theragran-M 100 100 NAAdvanced 100 200 100Formula High 150 35Potency 200 100Theragran-M 70 150 200 100Premier High 200 100Potency 100 100 200 200Theragran-M 70 100 150 31Premier 50 100 100 100 100 200Plus High 200 300 10 267Potency 150 13 100Therapeutic 100 10 235 125 100 + Vitamin 100 200 200 125 200Minerals 100 10 NAEnhanced 200 176Unicap M 150 100 100 125Unicap 100 200 150 100Senior 300 50 200 10 100Unicap T 100 50 100 100 500 NA NA 100 300 100 12 100 100 100 100 100 80 100 200 150 NA 100 10 82 833 100 667 80 100 100 588 100 110 500 100 100 300 NA 50 100 100 NA 300 NA 100 250

331 Ginkgo Ginkgo Trace Elements Trace Minerals Ca P Mg Fe Zn I Se K Mn Cu Cr Mo Other NatureMade 45Multi Daily NANatureMade 10 NAMulti Max 4 100NatureMade 20 100Multi 50+ 6 5 NANatureMade Multi 25 50 NAComplete 100NatureMade 45 NA 100Multi Daily NA NA 10NatureMade 10 100 100 NAMulti Max NA 8 100 4 1 100 100 71 NA 25 6 NA 100 NA 50 2 100 50 NA 100 Lycopene 100 100 100 100 NA 100 NA 100 35 NA 100 100 Lutein NA 1 1 33 NA 100 100 NA 100 100 Lycopene 100 100 33 NA Ginseng Lutein CentrumCentrum 10Performance 5 16Centrum 20Silver 11 10 5NatureMade 25 100Multi 25 100Complete 100 100 NA 100 100 100 100 10 100 29 2 8 29 2 200 25 2 100 100 50 100 100 100 100 100 100 100 100 100 125 35 100 1 Lycopene 100 100 100 33 Ginseng TABLE 13 (Continued) TABLE Element Composition of Selected Multivitamins and with Mineral Trace Supplements

332 )

Continued ( NatureMade 20Multi 50+ 5One-A-Day 1250 Plus 25 NAOne-A-Day NA 25Essential NAOne-A-Day 16 NA NAMaximum 100 150 11 NATherapeutic 7 100 100 NA 25 NAVitamin 71 150 NATheragran-M 4 NA 100 NAAdvanced 1 100 2 NAFormula High 3 NA 100Potency 200 NA NA 29 26 100Theragran-M 17 100 NA NAPremier High 100 50 11 2Potency 150 NA NA 100 25 100Theragran-M 20 120 33 100Premier 50 175 NA NA 100 5 Lutein Plus High 100 100 100 NA NAPotency 25 100 54 1Therapeutic 4 NA 286 + 0Vitamin 213 Minerals NA 3 100 2Enhanced 113 100 25 100 100 42 50 286 175 100 2 100 100 100 107 175 100 Lutein 100 <1 125 100 100 100 Lutein 42 100

333 Ca = calcium; Cr chromium; Cu Elements: Trace Elements Trace = Cyanocobalamin. 12 = Pyridoxine; B 6 = Pantothenic Acid; B 5 = Niacin; B 3 Many specialty vitamin combinations are available, but not included in this list. (Examples are vitamins B plus C, supplements for a Many specialty vitamin combinations are available, but not included in this list. (Examples vitamins B plus C, supplements 1 = Riboflavin; B 2 Minerals Ca P Mg Fe Zn I Se K Mn Cu Cr Mo Other = Thiamine; B 1 B Common generic brands (when other than the store name itself) are: Osco Drug Central-Vite (Albertson’s); Spectravite (CVS); Kir kland Signature Daily Multivitamin (Albertson’s); Common generic brands (when other than the store name itself) are: Osco Drug Central-Vite = copper; Fe = iron; Fl = fluoride; I = iodine; K = potassium; Mg = magnesium; Mn = manganese; Mo = molybdenum; P = phosphorus; Se = selenium; Zn zinc; NA = copper; Fe iron; Fl fluoride; I iodine; K potassium; Mg magnesium; Mn manganese; Mo molybdenum; P phosphorus; not applicable or available. (Costco); Whole Source, PharmAssure (Rite Aid); Central-Vite (Safeway); Member’s Mark (Sam’s Club); Vitasmart (Kmart); Century (Target); A thru Z Select, Super Aytinal, Club); Vitasmart (Kmart); Century Mark (Sam’s (Target); (Safeway); Member’s (Costco); Whole Source, PharmAssure (Rite Aid); Central-Vite Sentury-Vite (Wal-Mart). Equate Complete or Spring Valley Ultra Choice (Walgreens) Vitamins: Unicap MUnicap 6Senior 5 10 NA 8 100 100 8 100 NA 56 100 <1 100 50 NA 100 <1 NA 50 NA 100 NA NA TABLE 13 (Continued) TABLE Element Composition of Selected Multivitamins and with Mineral Trace Supplements Unicap TCommon multivitamins available without a prescription are listed. Most chain stores have generic versions of many the multiv itamin supplements listed above; thus, specific generic brands are not listed. NA NA NA1 100 100 100 14 <1 50 100 NA NA specific condition or organ, pediatric and infant formulations, and prenatal vitamins.) based on Recommended Dietary Allowances of vitamins and minerals based on Dietary Reference Intakes (Food and are listed as percentages of the Daily Value Values Nutrition Board, Institute of Medicine, National Academy Science).

334 Index

Abacavir (Ziagen), 6, 25 Achromycin V (tetracycline), 3, 271 Abatacept (Orencia), 17, 25 AcipHex (rabeprazole), 15, 242 Abbokinase (urokinase), 17, 286 Acitretin (Soriatane), 10, 28 Abciximab (ReoPro), 17, 25 Aconite, 307 Abelcet (amphotericin B lipid complex), Acova (argatroban), 16, 46 3, 42 ActHIB (haemophilus B conjugate Abilify (aripiprazole), 10, 46 vaccine), 18, 150 Abraxane (paclitaxel), 5, 219, 328 Actidose (charcoal, activated), 1, 75 Acamprosate (Campral), 24, 26 Actimmune (interferon gamma-1b), 17, Acarbose (Precose), 12, 26 165 Accolate (zafirlukast), 292 Actiq System (fentanyl, transmucosal), 21 Accupril (quinapril), 6, 241 Activase (alteplase, recombinant [tPA]), Accutane (isotretinoin [13-cis retinoic 17, 35 acid]), 11, 168 Activated Charcoal (SuperChar, Acebutolol (Sectral), 7, 26 Actidose, Liqui-Char), 1, 75 Aceon (perindopril erbumine), 6, 226 Actonel (risedronate), 13, 246 Acetadote (acetylcysteine), 1, 22, 23, 28 ActoPlus Met (pioglitazone/metformin), Acetaminophen [APAP] (Tylenol), 21, 12, 230 26, 310, 327, 328 Actos (pioglitazone), 12, 231 with Butalbital w/and w/o Caffeine Acular (ketorolac, ophthalmic), 14, 171 (Fioricet, Medigesic, Repan, Acyclovir (Zovirax), 6, 10, 29 Sedapap-10, Two-Dyne, Triapin, Adalat (nifedipine), 7, 207, 327 Axocet, Phrenilin Forte), 21, 27 Adalat CC (nifedipine), 7, 207, 327 with Codeine (Tylenol No. 3, 4), 21, 27 Adalimumab (Humira), 17, 29 Hydrocodone, Chlorpheniramine, Adapin (doxepin), 9, 108 Phenylephrine, Caffeine and, Adefovir (Hepsera), 6, 29 (Hycomine), 7, 22, 155 Adenocard (adenosine), 7, 30 Propoxyphene and, (Darvocet), Adenosine (Adenocard), 7, 30 21, 238 Adrenalin (epinephrine), 8, 22, 116 Acetazolamide (Diamox), 8, 13, 28 Adriamycin (doxorubicin), 4, 109 Acetic Acid and Aluminum Acetate (Otic Adrucil (fluorouracil [4-FU]), 4, 137 Domeboro), 12, 28 Advair Diskus (fluticasone propionate Acetylcysteine (Acetadote, Mucomyst), and salmeterol xinafoate), 1, 22, 23, 28 23, 140, 315

Advil (ibuprofen), 22, 158 Aldomet (methyldopa), 7, 191 AeroBid (flunisolide), 23, 137 Aldosterone Antagonist, 6 Afrinol (pseudoephedrine), 22, 240 Alefacept (Amevive), 10, 31 Agenerase (amprenavir), 6, 43, 328 Alendronate (Fosamax, Fosamax Aggrastat (tirofiban), 17, 277 Plus D), 13, 32 Aggrenox (dipyridamole and aspirin), Alesse, 318 17, 105 Aleve (naproxen), 22, 202 A-K Beta (levobunolol), 13, 175 Alfenta (alfentanil), 21, 32, 328 AK-Dex Ophthalmic (dexamethasone, Alfentanil (Alfenta), 21, 32, 328 ophthalmic), 14, 98 Alfuzosin (Uroxatral), 23, 32 AK-Dilate (phenylephrine, ophthalmic), Alginic Acid (Gaviscon), 15, 32 228 /Aluminum Hydroxide and AK-Neo-Dex Ophthalmic (neomycin Magnesium Trisilicate, 32 and dexamethasone), 14, 204 Alglucosidase alfa (Myozyme), 24, 32 AK Poly Bac Ophthalmic (bacitracin and Alimta (pemetrexed), 4, 5, 222 polymyxin B, ophthalmic), 14, 53 Alinia (nitazoxanide), 4, 208 AK Spore HC Ophthalmic (bacitracin, Aliskiren (Tekturna), 33 neomycin, polymyxin B, and Alka-Mints (calcium carbonate), 15, 64 hydrocortisone, ophthalmic), 14, 53 Alkeran (melphalan [L-PAM]), 4, 185 AKTob (tobramycin, ophthalmic), Alkylating agents, 4 14, 278 Allegra, Allegra-D (fexofenadine), AK-Tracin Ophthalmic (bacitracin, 1, 134 ophthalmic), 14, 53 Allopurinol (Zyloprim, Lopurin, Alamast (pemirolast), 14, 223 Aloprim), 19, 33 Alavert (loratadine), 1, 181 Almotriptan (Axert), 21, 33 Albalon-A-Ophthalmic (naphazoline and Aloe vera (Aloe barbadensis), 24, 296 antazoline), 14, 201 Alomide (lodoxamide), 13, 14, 180 Albumin (Albuminar, Buminate, Aloprim (allopurinol), 19, 33 Albutein), 17, 30 Alosetron (Lotronex), 16, 33 Albuminar (albumin), 17, 30 Aloxi (palonosetron), 15, 219

Albutein (albumin), 17, 30 Alpha1-adrenergic blocker, 6 Albuterol (Proventil, Ventolin, Volmax), Alpha1-protease inhibitor (Prolastin), 22, 30 23, 34 and Ipratropium (Combivent, Alphagan (brimonidine), 13, 60 DuoNeb), 22, 31 Alprazolam (Xanax, Niravam), Alclometasone dipropionate, 314 9, 34, 327

Aldactazide (hydrochlorothiazide and Alprostadil [Prostaglandin E1] (Prostin spironolactone), 8, 154 VR), 8, 34 Aldactone (spironolactone), 8, 259 Intracavernosal (Caverject, Edex), Aldara (Imiquimod cream 4%), 11, 160 23, 35 Aldesleukin [Interleukin-2, IL-2] Urethral Suppository (Muse), 23, 35 (Proleukin), 5, 31 Altabax (Retapamulin), 4, 244 Index 337

Altace (ramipril), 6, 243 Amitiza (lubiprostone), 16, 182 Alteplase, recombinant [tPA] (Activase), Amitriptyline (Elavil), 9, 22, 40 17, 35 Amlodipine (Norvasc), 7, 40 ALternaGEL (aluminum hydroxide), Amlodipine/Atorvastatin (Caduet), 8, 40 15, 36 Ammonium Aluminum Sulfate [Alum], Altocor (lovastatin), 8, 182, 328 23, 41 Altretamine (Hexalen), 4, 35 Amnesteem (isotretinoin [13-cis retinoic Aluminum Hydroxide (Amphojel, acid]), 11, 168 ALternaGEL), 15, 36 Amoxicillin (Amoxil, Polymox), 3, 41 with Magnesium Carbonate (Gaviscon and Clavulanic Acid (Augmentin, Extra Strength, Liquid), 15, 36 Augmentin 600 ES, Augmentin with Magnesium Hydroxide (Maalox), XR), 3, 41 15, 36 Amoxil (amoxicillin), 3, 41 with Magnesium Hydroxide and Amphetamines, 329 Simethicone (Mylanta, Mylanta II, Amphocin (amphotericin B), 41 Maalox Plus), 15, 36 Amphojel (aluminum hydroxide), 15, 36 with Magnesium Trisilicate (Gaviscon, Amphotec (amphotericin B cholesteryl), Gaviscon-2), 15 3, 42 with Magnesium Trisilicate (Gaviscon, Amphotericin B (Amphocin, Regular Strength), 37 Fungizone), 3, 10, 41 Alupent (metaproterenol), 22, 188 Amphotericin B Cholesteryl Amantadine (Symmetrel), 6, 9, 37 (Amphotec), 3, 42 Amaryl (Glimepiride), 12, 147 Amphotericin B Lipid Complex Ambien/Ambien CR (zolpidem), 10, 294 (Abelcet), 3, 42 AmBisome (amphotericin B liposomal), Amphotericin B Liposomal (AmBisome), 3, 42 3, 42 Amcill (ampicillin), 3, 42 Ampicillin (Amcill, Omnipen), 3, 42 Amcinonide, 314 Ampicillin-Sulbactam (Unasyn), 3, 43 Amerge (naratriptan), 21, 202 Amprenavir (Agenerase), 6, 43, 328 Amevive (alefacept), 10, 31 Anakinra (Kineret), 17, 43 Amicar (aminocaproic acid), 17, 38 Anaprox (naproxen), 22, 202 Amifostine (Ethyol), 1, 37 Anaspaz (hyoscyamine), 16, 23, 157 Amikacin (Amikin), 1, 37 Anastrozole (Arimidex), 5, 44 Amikin (amikacin), 1, 37 Ancef (cefazolin), 2, 69 Amiloride (Midamor), 8, 38 Androderm (testosterone), 12, 271 Aminocaproic acid (Amicar), 17, 38 AndroGel (testosterone), 12, 271 Amino-Cerv pH 4.4 Cream, 20, 38 Androxy, 5 Aminoglutethimide (Cytadren), 5, 38 Anectine (succinylcholine), 19, 262 Aminoglycosides, classification of, 1 Anestacon Topical (lidocaine), Aminophylline, 22, 39 177, 312, 326 Amiodarone (Cordarone, Pacerone), 7, Angelia (drospirenone/estradiol), 110, 39, 326, 328 320, 322 338 Index

Angiomax (bivalirudin), 16, 58 Antithrombotic agents, 17 Angiotensin II receptor antagonists, 7 Antithymocyte globulin [ATG] Angiotensin-Converting Enzyme (ACE) (ATGAM), 18, 182 inhibitors, 6 Antitussives, 22 Anidulafungin (Eraxis), 3, 44 Antiulcer agents, 15 Anistreplase (Eminase), 17, 44 Antivert (meclizine), 15, 185 Ansaid (flurbiprofen), 22, 139 Antivirals, classification of, 6 Antacids, 15 Anusol-HC Suppository (hydrocortisone, Anthra-Derm (anthralin), 10, 44 rectal), 16, 155 Anthralin (Anthra-Derm), 10, 44 Anusol Ointment (pramoxine), 11, 16, Antiallergy agents, 1 21, 234 Antianxiety agents, 9 Anzemet (dolasetron), 15, 107 Antiarrhythmic agents, 7, 326 Apokyn (apomorphine), 9, 45 Antibiotic agents, classification of, 3, 4 Apomorphine (Apokyn), 9, 45 Anticoagulants, 16, 325 Apraclonidine (Iopidine), 13, 45 Anticonvulsants, 9 Aprepitant (Emend), 15, 45 Antidepressants, 9 Apresoline (hydralazine), 8, 153 Antidiabetic agents, 12 Apri, 318 Antidiarrheals, 15 Aprotinin (Trasylol), 17, 46 Antidotes, 1 Aptivus (tipranavir), 277 Antiemetics, 15 Aquachloral (chloral hydrate), Antifungals, classification of, 3 10, 76 Antigout agents, 19 Aqua-MEPHYTON (phytonadione Antihemophilic Factor [AHF, Factor VIII] [Vitamin K]), 11, 229 (Monoclate), 45 ARA-C (cytarabine), 4, 91 Antihemophilic Factor VIII (Monoclate), Aranesp (darbepoetin alfa), 17, 94 17 Arava (leflunomide), 19, 173 Antihistamines, 1 Aredia (pamidronate), 13, 220 Antihypertensive agents, centrally Arformoterol (Brovana), 22, 46 acting, 7 Argatroban (Acova), 16, 46 Antihypertensive combination agents, 8 Arimidex (anastrozole), 5, 44 Antilirium (physostigmine), 1, 229 Aripiprazole (Abilify), 10, 46 Antimetabolites, 4 Aristolochic acid, 307 Antimicrobial agents, 1 Arixtra (fondaparinux), 16, 141 Antimycobacterials, classification of, 4 Arnica (Arnica montana), 24, 296 Antineoplastic agents, classification of, Aromasin (exemestane), 5, 130 4, 5 Arranon (nelarabine), 4, 203 Antiparkinson agents, 9 Artane (trihexyphenidyl), 9, 284 Antiplatelet agents, 17 Artificial tears (Tears Naturale), Antiprotozoals, classification of, 4 14, 47 Antipsychotics, 10 Asacol (mesalamine), 16, 187 Antiretrovirals, classification of, 6 L- Asparaginase (Elspar, Oncaspar), 5 Index 339

Aspirin (Bayer, Ecotrin, St. Joseph’s), Avelox (Moxifloxacin), 2, 198 17, 21, 47 Aventyl (nortriptyline), 9, 210 with Butalbital, Caffeine, and Codeine Aviane, 318 (Fiorinal with Codeine), 21, 48 Avinza XR (morphine), 21, 198, 329 and Butalbital Compound (Fiorinal), Avita (tretinoin, topical [Retinoic acid]), 21, 47 6, 11, 282 with Codeine (Empirin No. 2, 3, 4), Avodart (dutasteride), 23, 112 21, 48 Axert (almotriptan), 21, 33 Astelin (azelastine), 1, 52 Axid (nizatidine), 15, 209 Astragalus (Astragalus membranaceus), Axid AR (nizatidine), 15, 209 296 Axocet (acetaminophen, butalbital, and Atacand (candesartan), 7, 65 caffeine), 21, 27 Atarax (hydroxyzine), 1, 9, 10, 156 Azactam (aztreonam), 3, 53 Atazanavir (Reyataz), 6, 48, 328 Azathioprine (Imuran), 18, 52 Atenolol (Tenormin), 49 Azelastine (Astelin, Optivar), 1, 52 and chlorthalidone (Tenoretic), 7, 49 Azilect (rasagiline mesylate), 9, 243 Atgam (lymphocyte immune globulin Azithromycin (Zithromax), 2, 52 [antithymocyte globulin, ATG]), 18, Azmacort (triamcinolone), 23, 282, 182 316 Ativan (Lorazepam), 9, 181 Azopt (brinzolamide), 13, 60 Atomoxetine HCL (Strattera), 10, 49 Aztreonam (Azactam), 3, 53 Atorvastatin (Lipitor), 8, 50, 328 Azulfidine/Azulfidine EN Atovaquone (Mepron), 6, 50 (sulfasalazine), 263 Atovaquone/Proguanil (Malarone), 6, 50 Atracurium (Tracrium), 19, 50 B and O Supprettes (belladonna and Atripla (efavirenz, emtricitabine, opium suppositories), 23, 55 tenofovir), 6, 113 Baciguent (Bacitracin, topical), 10, 53 Atropine (AtroPen), 1, 7, 14, 50 Bacillus Calmette-Guérin [BCG] ophthalmic (Isopto Atropine, generic), (Thera-Cys, Tice BCG), 6, 54 51 Bacitracin /pralidoxime (DuoDote), 51 Neomycin, and Polymyxin B, Atrovent (ipratropium), 23, 166 ophthalmic (AK Spore Ophthalmic, A/T/S (erythromycin, topical), 11, 120 Neosporin Ophthalmic), 14, 53 Augmentin (amoxicillin and clavulanic Neomycin, and Polymyxin B, Topical acid), 3, 41 (Neosporin Ointment), 10, 53 Auralgan (benzocaine and antipyrine), Neomycin, Polymyxin B, and Hydro- 12, 21, 56 cortisone, Ophthalmic (AK Spore Avandamet (rosiglitazone/metformin), HC Ophthalmic, Cortisporin Oph- 249 thalmic), 14, 53 Avandia (Rosiglitazone), 12, 249 and Neomycin, Polymyxin B, and Avapro (irbesartan), 7, 166 Hydrocortisone, Topical Avastin (Bevacizumab), 5, 57 (Cortisporin), 10, 53 340 Index

Bacitracin (Cont.): Beractant (Survanta), 23, 56 and Neomycin, Polymyxin B, and Beta-adrenergic blockers, 7 Lidocaine, Topical (Clomycin), Betagan (levobunolol), 13, 175 10, 53 Betamethasone, 3, 11, 86, 313, 314 Ophthalmic (AK-Tracin Ophthalmic), Betapace (sotalol), 7, 258, 326 14, 53 Betapace AF (sotalol), 7, 258, 326 and Polymyxin B, Ophthalmic Betaseron (interferon beta-1b), 17, 165 (AK Poly- Bac Ophthalmic, Poly- Betaxolol (Kerlone), 7, 56 sporin Ophthalmic), 14, 53 Ophthalmic (Betopic), 13, 57 and Polymyxin B, Topical Bethanechol (Urecholine, Duvoid), 23, (Polysporin), 10, 53 57 Topical (Baciguent), 10, 53 Betopic (betaxolol, ophthalmic), 13, 57 Baclofen (Lioresal Intrathecal), 19, 53 Bevacizumab (Avastin), 5, 57 Bactocill (oxacillin), 3, 215 Biaxin/Biaxin XL (clarithromycin), 2, Bactrim (trimethoprim-sulfamethoxazole 82, 328 [Co-Trimoxazole]), 3 Bicalutamide (Casodex), 5, 57 Bactroban (mupirocin), 11, 199 Bicarbonate. See Sodium Bicarbonate

Balsalazide (Colazal), 16, 54 [NaHCO3] Basiliximab (Simulect), 18, 54 Bicillin (penicillin G benzathine), 3, 223 Bayer (aspirin), 17, 21, 47 Bicitra (sodium citrate), 23, 256 BCG [Bacillus Calmette-Guérin] BiCNU (carmustine [BCNU]), 4, 67 (Thera-Cys, Tice BCG), 5, 54 BiDil (isosorbide dinitrate and Becaplermin (Regranex Gel), 24, 55 hydralazine HCL), 168 Beclomethasone (Beconase, Vancenase Bilberry (Vaccinium myrtillus), 24, 297 Nasal Inhaler, QVAR), 23, 55 Bisacodyl (Dulcolax), 16, 57 Beconase (beclomethasone), 23, 55 Bismuth Subcitrate/Metronidazole/ Belladonna and Opium Suppositories Tetracycline (Pylera), 58 (B and O Supprettes), 23, 55 Bismuth Subsalicylate (Pepto-Bismol), Benadryl (diphenhydramine), 1, 10, 104 15, 58 Benazepril (Lotensin), 6, 55 Bisoprolol (Zebeta), 7, 58 Benemid (probenecid), 19, 236 Bivalirudin (Angiomax), 16, 58 Benign prostatic hyperplasia Black cohosh (Cimicifuga racemosa), medications, 23 24, 297 Bentyl (Dicyclomine), 16, 101 Blenoxane (bleomycin sulfate), 4, 59 Benylin DM (dextromethorphan), Bleomycin sulfate (Blenoxane), 4, 59 22, 99, 329 Bleph-10 (sulfacetamide), 14, 263 Benzamycin (erythromycin benzoyl Blephamide (sulfacetamide and peroxide), 120 prednisolone), 12, 14, 263 Benzocaine and Antipyrine (Auralgan), Blocadren (timolol), 7, 275, 327 12, 21, 56 Bogbean (Menyanthes trifoliate), 24, 297 Benzonatate (Tessalon Perles), 22, 56 Boniva (ibandronate), 13, 157 Benztropine (Cogentin), 9, 56 Borage (Borago officinalis), 24, 298 Index 341

Bortezomib (Velcade), 5, 59 Calcijex (Calcitriol), 12, 63 Botox Cosmetic (Botulinum toxin Calcipotriene (Dovonex), 10, 63 type A), 10, 59 Calcitonin (Cibacalcin, Fortical, Botulinum toxin type A (Botox Miacalcin), 12, 63 Cosmetic), 10, 59 Calcitriol (Rocaltrol, Calcijex), 12, 63 Brethine (terbutaline), 20, 22, 270 Calcium Acetate (Calphron, Phos-Ex, Brevibloc (Esmolol), 7, 120, 326 PhosLo), 11, 64 Brevicon, 318 Calcium Carbonate (Tums, Alka-Mints), Bricanyl (terbutaline), 20, 22, 270 15, 64 Brimonidine (Alphagan P), 13, 60 Calcium channel antagonists, 7 Brinzolamide (Azopt), 13, 60 Calcium Glubionate (Neo-Calglucon), Bromocriptine (Parlodel), 9, 60 11, 64 Bronchodilators, 22 Calcium Salts [Chloride, Gluconate, Brontex (guaifenesin and codeine), 22, 150 Gluceptate], 11, 64 Brovana (Arformoterol), 22, 46 Calfactant (Infasurf), 23, 65 Budesonide (Rhinocort, Aqua, Entocort Calphron (calcium acetate), 11, 64 EC, Pulmicort), 1, 16, 23, 60, 328 Camila, 321 Budesonide/Formoterol (Symbicort), Campral (acamprosate), 24, 26 23, 61 Camptosar (irinotecan), 5, 166 oral (Entocort EC), 61 Cancidas (caspofungin), 3, 68 Bugleweed (Lycopus virginicus), 24, 298 Candesartan (Atacand), 7, 65 Bumetanide (Bumex), 8, 61 Capoten (captopril), 6, 65 Bumex (bumetanide), 8, 61 Capsaicin (Capsin, Zostrix), 10, 21, 65 Buminate (albumin), 17, 30 Capsicum (Capsicum frutescens), 24, Bupivacaine (Marcaine), 21, 61, 312 298 Buprenex (buprenorphine), 21, 62 Capsin (capsaicin), 10, 21, 65 Buprenorphine (Buprenex), 21, 62 Captopril (Capoten), 6, 65 Bupropion (Wellbutrin, Wellbutrin SR, Carafate (sucralfate), 15, 263 Wellbutrin XL, Zyban), 62 Carbamazepine (Tegretol), 328 BuSpar (buspirone), 9, 62, 329 Carbamazepine (Tegretol XR, Carbatrol, Buspirone (BuSpar), 9, 62, 329 Epitol), 9, 65, 328 Busulfan (Myleran, Busulfex), 4, 62 Carbapenems, 119, 159, 187 Busulfex (busulfan), 4, 62 classification of, 2 Butcher’s broom (Ruscus aculeatus), Carbatrol (carbamazepine), 9, 65, 328 24, 298 Carbidopa/levodopa (Sinemet, Parcopa), Butorphanol (Stadol), 21, 63 9, 66 Byetta (exenatide), 130 Carboplatin (Paraplatin), 4, 67 Cardene (nicardipine), 7, 206 Caduet (amlodipine/atorvastatin), 8, 40 Cardiovascular (CV) agents, Caffeine, 327 classification of, 6, 9 Calamus, 307 Cardizem (diltiazem), 7, 102, 326, 327, Calan (verapamil), 7, 289, 326, 327, 328 328 342 Index

Cardura (doxazosin), 6, 23, 108 Ceftin [oral] (Zinacef [parenteral], Carisoprodol (Soma), 19, 67 Cefuroxime), 2, 73 Carmustine [BCNU] (BiCNU, Gliadel), Ceftizoxime (Cefizox), 2, 73 4, 67 Ceftriaxone (Rocephin), 2, 73 Carteolol (Cartrol, Ocupress Cefuroxime (Ceftin [oral], Zinacef Ophthalmic), 7, 13, 68 [parenteral]), 2, 73 Cartia XT (diltiazem), 7, 102, 326, Cefzil (cefprozil), 2, 72 327, 328 Celebrex (celecoxib), 22, 74 Cartrol (carteolol), 7, 13, 68 Celecoxib (Celebrex), 22, 74 Carvedilol (Coreg, Coreg CR), Celexa (Citalopram), 9, 82 7, 68 CellCept (mycophenolate mofetil), Cascara Sagrada (Rhamnus purshiana), 18, 199 299 Cenestin (Estrogen, conjugated- Casodex (Bicalutamide), 5, 57 synthetic), 20, 124 Caspofungin (Cancidas), 3, 68 Central nervous system agents, Cataflam (diclofenac), 22, 100 classification of, 9, 10 Catapres (clonidine), 7 Centrally acting antihypertensive agents, Catapres TTS (clonidine, transdermal), 7 84 Cephalexin (Keflex, Keftab, Pranixine Cathartics/Laxatives, 16 Disperdose), 2, 74 Caverject (alprostadil, intracavernosal), Cephalosporins 23, 35 first generation, classification of, Ceclor (cefaclor), 2 69, 74, 75 Cedax (Ceftibuten), 2, 73 fourth generation, classification of, Cefaclor (Ceclor, Raniclor), 2, 68 70 Cefadroxil (Duricef, Ultracef), 2, 69 second generation, classification of, Cefazolin (Ancef, Kefzol), 2, 69 68, 71, 72, 181 Cefdinir (Omnicef), 2, 69 third generation, classification of, 69, Cefditoren (Spectracef), 2, 70 70, 71, 72, 73 Cefepime (Maxipime), 2, 70 Cephradine (Velosef), 2, 75 Cefixime (Suprax), 2, 70 Cephulac (lactulose), 16 Cefizox (ceftizoxime), 2, 73 Cerebyx (fosphenytoin), 9, 142 Cefobid (cefoperazone), 2, 71 Cerubidine (daunomycin), 4, 95 Cefoperazone (Cefobid), 2, 71 Cerumenex (triethanolamine), 12, 283 Cefotaxime (Claforan), 2, 71 Cervidil Vaginal Insert (dinoprostone), Cefotetan (Cefotan), 2, 71 20, 103 Cefoxitin (Mefoxin), 2, 71 Cesamet (nabilone), 15, 200 Cefpodoxime (Vantin), 2, 72 Cetamide (sulfacetamide), 14, 263 Cefprozil (Cefzil), 2, 72 Cetirizine (Zyrtec, Zyrtec D), 1, 75 Ceftazidime (Fortaz, Ceptaz, Tazidime, Cetuximab (Erbitux), 5, 75 Tazicef), 2, 72 Chamomile (Matricaria recutita), Ceftibuten (Cedax), 2, 73 24, 299 Index 343

Chantix (varenicline), 24, 288 Cipro HC Otic (ciprofloxacin, otic), Chaparral, 307 12, 81 Charcoal (SuperChar, Actidose, Ciprofloxacin (Cipro), 2, 11, 328 Liqui-Char Activated), 1, 75 Ophthalmic (Ciloxan), 13, 14, 81 Chemet (succimer), 1, 262 Otic (Cipro HC Otic), 12, 81 Chibroxin (noroxin), 13, 328 Cisapride, 328 Chibroxin Ophthalmic (norfloxacin), 209 Cisplatin (Platinol, Platinol AQ), 4, 82 Chinese herbal mixtures, 307 Citalopram (Celexa), 9, 82 Chitosamine (glucosamine sulfate), Cladribine (Leustatin), 5, 82 24, 303 Claforan (cefotaxime), 2, 71 Chloral Hydrate (Aquachloral, Claravis (isotretinoin [13-cis retinoic Supprettes), 10, 76 acid]), 11, 168 Chlorambucil (Leukeran), 4, 76 Clarinex (desloratadine), 1, 97 Chlordiazepoxide (Librium, Mitran, Clarithromycin (Biaxin, Biaxin XL), Libritabs), 9, 76 2, 82, 328 Chlorothiazide (Diuril), 8, 77 Claritin (loratadine), 1, 181 Chlorpheniramine (Chlor-Trimeton), Clemastine Fumarate (Tavist, Dayhist, 1, 77, 329 Antihist-1), 1, 83 Chlorpromazine (Thorazine), 10, 15, 77 Cleocin (clindamycin), 3, 11, 83 Chlorpropamide (Diabinese), 12, 78 Cleocin-T (clindamycin), 3, 11, 83 Chlorthalidone (Hygroton), 8, 78 Climara (estradiol, transdermal), 20, 123 Chlor-Trimeton (chlorpheniramine), Clindamycin (Cleocin, Cleocin-T), 1, 77, 329 3, 11, 83 Chlorzoxazone (Paraflex, Parafon Forte Clinoril (sulindac), 22, 264 DSC), 19, 78 Clobetasol propionate, 314

Cholecalciferol [Vitamin D3] (Delta D), Clocortolone pivalate, 314 11, 79 Clofarabine (Clolar), 4, 84 Cholestyramine (Questran, Prevalite, Clolar (Clofarabine), 4, 84 Locholest), 8, 79 Clomipramine, 327 Chondroitin Sulfate, 24, 299 Clomycin (bacitracin, neomycin, Chronulac (lactulose), 16 polymyxin B, and lidocaine, Cialis (tadalafil), 24, 265, 328 topical), 10, 53 Cibacalcin (calcitonin), 12 Clonazepam (Klonopin), 9, 84 Ciclesonide (Omnaris), 79 Clonidine (Catapres), 7 Ciclopirox (Loprox, Penlac), 11, 79 transdermal (Catapres TTS), 84 Cidofovir (Vistide), 6, 80 Clopidogrel (Plavix), 17, 85 Cilostazol (Pletal), 24, 80 Clopra (metoclopramide), 15, 192 Ciloxan (ciprofloxacin, ophthalmic), Clorazepate (Tranxene), 9, 85 13, 14, 81 Clotrimazole (Lotrimin, Mycelex), Cimetidine (Tagamet), 15, 80, 327 3, 85 Cinacalcet (Sensipar), 13, 81 and betamethasone (Lotrisone), Cipro (ciprofloxacin), 2, 11 3, 11, 86 344 Index

Clozapine (Clozaril, FazaClo), Cortef (hydrocortisone topical and 10, 86, 327 systemic), 12, 155, 313 Clozaril (clozapine), 10, 86, 327 Corticosteroid. See Prednisolone Cocaine, 21, 86, 328, 329 Cortisol, 328 Codeine, 21, 22, 86, 327 Cortisone (Cortone), 88, 313 Cogentin (benztropine), 9, 56 Systemic, Topical, 12 Cognex (tacrine), 10, 265 Cortisporin, 10, 53 Colace (docusate sodium), 16, 106 Ophthalmic (AK Spore HC Colazal (Balsalazide), 16, 54 Ophthalmic, Bacitracin, neomycin, Colchicine, 19, 87 polymyxin B, and hydrocortisone, Colesevelam (WelChol), 8, 87 ophthalmic), 14, 53 Colestid (Colestipol), 8, 87 Corticosporin-TC Otic Drops (neomycin, Colestipol (Colestid), 8, 87 colistin, and hydrocortisone), 12, 203 Coltsfoot, 307 Corticosporin-TC Otic Suspension CoLyte (polyethylene glycol-electrolyte (neomycin, colistin, hydrocortisone, solution), 16, 232 and thonzonium), 12, 203 Combivent (albuterol and ipratropium), Corvert (ibutilide), 7, 158 22, 31 Cosmegen (dactinomycin), 4, 92 Combivir (zidovudine and lamivudine), Cosopt (dorzolamide and timolol), 6, 293 13, 108 Combunox (oxycodone/ibuprofen), 218 Cotazym (pancrease), 16, 220 Comfrey (Symphytum officinale), 24, Co-Trimoxazole (Septra, Bactrim, 299, 307 Trimethoprim-Sulfamethoxazole, 3 Compazine (prochlorperazine), 10, 15, Coumadin (warfarin), 16, 291, 327 237 Cozaar (losartan), 7, 182 Comtan (entacapone), 9, 115 Cranberry (Vaccinium macrocarpon), Concerta (methylphenidate, oral), 10 24, 300 Condylox (podophyllin), 11, 232 Creon (pancreatin, pancrelipase), 16, 220 Condylox Gel 0.4% (podophyllin), Crestor (rosuvastatin), 8, 250 11, 232 Crixivan (indinavir), 6, 161, 328 Conivaptan HCL (Vaprisol), 87 Cromolyn sodium (Intal, NasalCrom, Constulose (lactulose), 16, 172 Opticrom), 1, 14, 23, 88 Contraceptives, 19 Cryselle, 318 Copegus (ribavirin), 4, 245 Cubicin (daptomycin), 6, 94

Copper IUD Contraceptive (ParaGard T Cyanocobalamin [Vitamin B12] 380A), 19, 88 (Nascobal), 11, 88 Cordarone (amiodarone), 7, 39, 326, 328 Cyclessa, 320 Coreg (carvedilol), 7, 68 Cyclobenzaprine (Flexeril), 19, 89 Corgard (nadolol), 7, 200 extended release (Amrix), 19, 89 Coriander (Coriandrum sativum), Cyclogyl (cyclopentolate), 14 24, 300 Cyclomydril (cyclopentolate with Corlopam (fenoldopam), 8, 131 phenylephrine), 14, 89 Index 345

Cyclopentolate Darunavir (Prezista), 95 ophthalmic (Cyclogyl, Cyclate), 14 Darvocet (propoxyphene and with Phenylephrine (Cyclomydril), acetaminophen), 21, 238 14, 89 Darvon (propoxyphene), 21, 238, 327 Cyclophosphamide (Cytoxan, Neosar), Compound-65 (propoxyphene and 4, 90, 328 aspirin), 21, 238 Cyclosporine (Sandimmune, NePO, Darvon-N with aspirin (propoxyphene Gengraf), 18, 90, 328 and aspirin), 21, 238 Ophthalmic (Restasis), 13, 14, 91 Dasatinib (Sprycel), 95 Cymbalta (duloxetine), 9, 111 Daunomycin (daunorubicin), 4, 95 Cyproheptadine (Periactin), 1, 91 Daunorubicin (Daunomycin, Cystospaz (hyoscyamine), 16, 23, 157 Cerubidine), 4, 95 Cytadren (aminoglutethimide), 5, 38 Dayhist-1 (clemastine fumarate), 1, 83 Cytarabine [ARA-C] (Cytosar-U), 4, 91 Daypro (oxaprozin), 22, 215 Cytarabine Liposome (DepoCyt), 4, 91 Daytrana (Methylphenidate, Cytochorme P-450 Isoenzymes, transdermal), 10, 191 327, 328 DDAVP (desmopressin), 12, 17, 97 CytoGam (Cytomegalovirus immune Decadron (dexamethasone), 12, 313, 314 globulin [CMV-IG IV]), 18, 92 Ophthalmic (dexamethasone, Cytomegalovirus Immune globulin ophthalmic), 14, 98 [CMV-IG IV] (CytoGam), 18, 92 Decitabine (Dacogen), 17, 96 Cytomel (liothyronine), 13, 179 Declomycin (demeclocycline), 13, 96 Cytosar-U (cytarabine [ARA-C]), 4, 91 Decongestants, 22 Cytotec (Misoprostol), 16, 196 Deferasirox (Exjade), 1, 96 Cytovene (ganciclovir), 6, 144 Delavirdine (Rescriptor), 6, 96, 328

Cytoxan (cyclophosphamide), 4, 90, 328 Delta D (cholecalciferol [Vitamin D3]), 11, 79 Dacarbazine (DTIC), 5, 92 Demadex (torsemide), 8, 280 Daclizumab (Zenapax), 18, 92 Demeclocycline (Declomycin), 13, 96 Dacogen (decitabine), 17, 96 Demerol (meperidine), 9, 289, 329 Dactinomycin (Cosmegen), 4, 92 Demulen, 318 Dalmane (flurazepam), 10, 138 Denavir (penciclovir), 6, 11, 223 Dalteparin (Fragmin), 16, 93 Depakene (valproic acid), 9, 287 Danaparoid (Orgaran), 17 Depakote (valproic acid), 9, 287 Dantrium (dantrolene), 19, 93 DepoCyt (cytarabine liposome), 4, 91 Dantrolene (Dantrium), 19, 93 DepoDur (morphine, liposomal), 21, 198 Dapsone Depo-Provera (medroxyprogesterone), oral, 4, 93 19, 20, 185 topical (Aczone), 11, 94 Depot, 5 Daptomycin (Cubicin), 6, 94 Deprenyl, 327 Darbepoetin Alfa (Aranesp), 17, 94 Dermatologic agents, classification Darifenacin (Enablex), 23, 94, 327 of, 10 346 Index

Desipramine (Norpramin), 9, 97 Dicloxacillin (Dynapen, Dycill), 3, 100 Desloratadine (Clarinex), 1, 97 Dicyclomine (Bentyl), 16, 101 Desmopressin (DDAVP, Stimate), 12, 17, Didanosine [ddl] (Videx), 6, 101 97 Didronel (etidronate disodium), 13, 128 Desogen, 318 Dietary supplements, 11 Desogestrel, 318, 319, 320 Diflucan (fluconazole), 3, 136, 327, 328 Desonide, 314 Diflunisal (Dolobid), 22, 101 Desoximetasone, 314 Digibind (Digoxin Immune Fab), Desyrel (trazodone), 9, 282, 328 1, 102 Detrol/Detrol LA (tolterodine), 24, 279, Digoxin (Digitek, Lanoxin, Lanoxicaps), 327 7, 8, 102 Detussin (hydrocodone and Digoxin Immune Fab (Digibind, pseudoephedrine), 22, 155 DigiFab), 1, 102 Dexacort Phosphate Turbinaire Dilacor (Diltiazem), 7, 102, 326, 327, 328 (dexamethasone, nasal), 23, 98 Dilantin (phenytoin), 9, 228, 326, 327, Dexamethasone (Decadron), 12, 313 328 Nasal (Dexacort Phosphate Dilatrate-SR (isosorbide dinitrate), Turbinaire), 23, 98 8, 167 Ophthalmic (AK-Dex Ophthalmic, Dilaudid (hydromorphone), 21, 156 Decadron Ophthalmic), 14, 98 Diltia XT (diltiazem), 7, 102, 326, Systemic, topical (Decadron), 98 327, 328 DexFerrum (iron dextran), 11, 166 Diltiazem (Cardizem, Cardizem CD, Dexpanthenol (Ilopan-Choline Oral, Cardizem SR, Cartia XT, Dilacor XR, Ilopan-Choline PO, Ilopan), 16, 98 Diltia XT, Taztia XT, Tiamate, Dexrazoxane (Zinecard), 1, 98 Tiazac), 7, 102, 326, 327, 328 Dextran 40 (Gentran 40, Dimenhydrinate (Dramamine), 15, 103 Rheomacrodex), 17, 98 Dimethyl Sulfoxide [DMSO] (Rimso 50), Dextromethorphan (Mediquell, Benylin 23, 103 DM, PediaCare 1, Delsym), Dinoprostone (Cervidil Vaginal Insert, 22, 99, 329 Prepidil Vaginal Gel, Prostin E2), Dey-Drop (silver nitrate), 14, 24, 254 20, 103 DiaBeta (glyburide), 21, 148 Diovan (valsartan), 7, 287 Diabinese (chlorpropamide), 12, 78 Dipentum (olsalazine), 16, 212 Dialose (docusate potassium), Diphenhydramine (Benadryl), 1, 10, 104 16, 106 Diphenoxylate with Atropine (Lomotil, Diamox (Acetazolamide), 8, 13, 28 Lonox), 15, 104 Diazepam (Valium, Diastat), 9, 19, Diphtheria, Tetanus Toxoids, and 99, 327 Acellular pertussis adsorbed, Diazoxide (Proglycem), 13, 100 Hepatitis B (recombinant), and Dibucaine (Nupercainal), 11, 16, 21, 100 Inactivated Poliovirus Vaccine (IPV) Diclofenac (Cataflam, Flector, Voltaren), combined (Pediarix), 18, 104 22, 100 Dipivefrin (Propine), 13, 105 Index 347

Diprivan (propofol), 10 Dramamine (dimenhydrinate), 15, 103 Dipyridamole (Persantine), 17, 105 Dronabinol (Marinol), 15, 110 Dipyridamole and Aspirin (Aggrenox), Droperidol (Inapsine), 15, 109 17, 105 Drospirenone Dirithromycin (Dynabac), 2, 105 Drospirenone/estradiol (Angelia), 110, Disopyramide (NAPamide, Norpace, 320, 322 Norpace CR, Rhythmodan), 7, 105, Drospirenone/ethinyl estradiol (YAZ), 326 110, 126, 322 Ditropan/Ditropan DL (oxybutynin), Drotrecogin alfa (Xigris), 24, 111 23, 216, 327 Droxia (hydroxyurea), 5, 156 Diuretics, 8 Dryvax (smallpox vaccine), 256 Diuril (chlorothiazide), 8, 77 DTIC (dacarbazine), 5, 92 Dobutamine (Dobutrex), 8, 106 Duetact (pioglitazone HCL/glimepiride), Dobutrex (dobutamine), 8, 106 147, 230 Docetaxel (Taxotere), 5, 106 Dulcolax (Bisacodyl), 16, 57 Docusate Calcium (Surfak), 16, 106 Duloxetine (Cymbalta), 9, 111 Docusate Potassium (Dialose), 16, 106 DuoDote, 51 Docusate Sodium (Doss, Colace), 16, 106 Duragesic (fentanyl, transdermal), 21, 132 Dofetilide (Tikosyn), 7, 107 Duramorph (morphine), 21, 198, 329 Dolasetron (Anzemet), 15, 107 Duricef (cefadroxil), 2, 69 Dolobid (diflunisal), 22, 101 Dutasteride (Avodart), 23, 112 Dolophine (methadone), 21, 189 Duvoid (bethanechol), 23, 57 Dong quai (Angelica polymorpha, Dyazide (hydrochlorothiazide and sinensis), 24, 300 triamterene), 8, 154 Donnatal (Hyoscyamine, atropine, Dycill (dicloxacillin), 3, 100 scopolamine, and phenobarbital), Dynabac (dirithromycin), 2, 105 16, 157 DynaCirc (Isradipine), 7, 169 Dopamine (Intropin), 8, 107 Dynapen (dicloxacillin), 3, 100 Doral (quazepam), 241 Dyrenium (triamterene), 8, 283 Dornase Alfa (Pulmozyme, Dnase), 23, 108 Ear (otic) agents, 12 Dorzolamide (Trusopt), 13, 108 Echinacea (Echinacea purpurea), and Timolol (Cosopt), 13, 108 24, 300 Doss (docusate sodium), 16, 106 Echothiophate Iodine (Phospholine Dovonex (calcipotriene), 10, 63 Ophthalmic), 13, 112 Doxazosin (Cardura, Cardura XL), 6, 23, Econazole (Spectazole), 3, 11, 112 108 Ecotrin (aspirin), 17, 21, 47 Doxepin (Sinequan, Adapin), 9, 108 Eculizumab (Soliris), 24, 112 Topical (Zonalon, Prudoxin), 11, 109 Edex (alprostadil, intracavernosal), Doxorubicin (Adriamycin, Rubex), 4, 109 23, 35 Doxycycline (Adoxa, Periostat, Oracea, Edrophonium (Tensilon, Enlon, Vibramycin, Vibra-Tabs), 3, 109 Reversol), 19, 112 348 Index

Efalizumab (Raptiva), 11, 113 Enoxaparin (Lovenox), 16, 115 Efavirenz (Sustiva), 6, 113, 328 Enpresse, 320 Efavirenz, emtricitabine, tenofovir Entacapone (Comtan), 9, 115 (Atripla), 6, 113 Enulose (lactulose), 16, 172 EfferSyllium (psyllium), 16, 240 Enzone (pramoxine with Effexor/Effexor XR (venlafaxine), hydrocortisone), 11, 16, 234 9, 289, 329 Enzymes, 16 Efudex (fluorouracil, topical), 137 Ephedra/Ma Huang, 24, 301, 307 Elavil (amitriptyline), 9, 22, 40 Ephedrine, 22, 116 Eldepryl (selegiline), 9, 252 Epinastine (Elestat), 13, 117 Elestat (epinastine), 13, 117 Epinephrine (adrenalin, Sus-Phrine, Eletriptan (Relpax), 21, 114 EpiPen, EpiPen Jr.,), 8, 22, 116 Elidel (pimecrolimus), 11, 229 EpiPen (epinephrine), 8, 22, 116 Eligard (leuprolide), 5, 174 Epirubicin (Ellence), 4, 117 Elimite (permethrin), 11, 226 Epitol (carbamazepine), 9, 65, 328 Elitek (rasburicase), 5, 244 Epivir (lamivudine), 6, 172 Ellence (epirubicin), 4, 117 Epivir-HBV (lamivudine), 6, 172 Elmiron (pentosan polysulfate), 23, 225 Eplerenone (Inspra), 6, 117 Eloxatin (oxaliplatin), 4, 215 Epoetin Alfa [Erythropoietin, EPO] Elspar (L-asparaginase,), 5 (Epogen, Procrit), 17, 117 Emadine (emedastine), 4, 114 Epogen (epoetin alfa [erythropoietin]), Emcyt (estramustine phosphate), 5, 124 17, 117 Emedastine (Emadine), 14, 114 Epoprostenol (Flolan), 8, 118 Emend (aprepitant), 15, 45 Eprosartan (Teveten), 7, 118 Emergency contraceptives, 19 Eptifibatide (Integrilin), 17, 118 Eminase (anistreplase), 17, 44 Equanil (Meprobamate, Miltown), 9, 187 EMLA (lidocaine and prilocaine), Eraxis (anidulafungin), 3, 44 7, 21, 178 Erbitux (cetuximab), 5, 75 Empirin (aspirin with codeine), 21, 48 Ergamisol (Levamisole), 5 Emsam (selegiline transdermal), 9, 252 Erlotinib (Tarceva), 5, 118, 328 Emtricitabine (Emtriva), 114 Errin, 321 Emtricitabine (Emtriva,Truvada), Ertaczo (sertaconazole), 3, 252 6, 114, 269 Ertapenem (Invanz), 2, 119 Emtriva (Emtricitabine), 6, 114 Erycette (erythromycin, topical), Enablex (darifenacin), 23, 94, 327 11, 120 Enalapril (Vasotec), 6, 114 Eryderm (erythromycin, topical), 11, 120 Enbrel (etanercept), 17, 126 Erythromycin (E-Mycin, E.E.S., Encainide, 327 Ery-Tab), 2, 119, 328 Endocrine system agents, classification and benzoyl peroxide (benzamycin), of, 12, 13 120 Enfuvirtide (Fuzeon), 6, 115 Ophthalmic (Ilotycin Ophthalmic), 14, Engerix-B (hepatitis B vaccine), 18, 152 119, 120 Index 349

and sulfisoxazole (Eryzole, Estrogen Pediazole), 2, 120 conjugated (Premarin), 20, 124 Topical (A/T/S/, Eryderm, Erycette, with medroxyprogesterone (Prempro, T-Stat), 11, 120 Premphase), 20, 125 Eryzole (erythromycin and sulfisoxazole), with methylprogesterone (Premarin 2, 120 with methylprogesterone), 20, 125 Escitalopram (Lexapro), 9, 120 with methyltestosterone (Premarin Esidrix (hydrochlorothiazide), 8, 153 with methyltestosterone), 20, 125 Eskalith (lithium carbonate), 10, 179 conjugated synthetic (Cenestin, Esmolol (Brevibloc), 7, 120, 326 Enjuvia), 20, 124 Esomeprazole (Nexium), 15, 121 Estrogen/Progestin combinations, 20, Estazolam (ProSom), 10, 121 318–320 Esterified Estrogens (Estratab, Menest), supplementation agents, 20 20, 121 Estrostep, 318 with methyltestosterone (Estratest, Eszopiclone (Lunesta), 10, 125 Estratest HS, Syntest DS, HS), Etanercept (Enbrel), 17, 126 20, 122 Ethambutol (Myambutol), 4, 126 Estinyl (ethinyl estradiol), 126, 318, 319, Ethinyl Estradiol (Estinyl, Feminone), 320, 321, 322 126, 318, 319, 320, 321, 322 Estrace (Estradiol), 20, 122 and drospirenone (YAZ), 110, Estracyt (estramustine phosphate), 126, 322 5, 124 and levonorgestrel (Preven), 19, 127 Estraderm (estradiol, transdermal), 20, Ethinyl Estradiol/Levonorgestrel 123 (Seasonal), 127 17-β Estradiol, 328 and Norelgestromin (Ortho Evra), Estradiol (Estrace, others), 20, 122 128 cypionate and medroxyprogesterone Ethosuximide (Zarontin), 9, 128 Acetate (Lunelle), 19, 123 Ethynodiol diacetate, 318, 320 gel (Elestrin), 20, 122 Ethyol (amifostine), 1, 37 Estradiol/Levonorgestrel, transdermal Etidronate Disodium (Didronel), 13, 128 (Climara Pro), 20, 123 Etodolac, 22, 128 Estradiol/Norethindrone Acetate Etonogestrel (FemHRT, Activella), 20, 123 Etonogestrel/Ethinyl Estradiol Transdermal (Estraderm, Climara, (NuvaRing), 19, 129 Vivelle, Vivelle Dot), 20, 123 Implant (Implanon), 19 Estramustine phosphate subdermal implant (Implanon), 129 estracyt, 5 Etoposide [VP-16] (VePesid, Toposar), Estramustine Phosphate (Estracyt, 5, 129 Emcyt), 4, 124 Eulexin (Flutamide), 5, 139 Estratab (Esterified estrogens), 20, 121 Evening Primrose Oil (Oenothera Estratest (Esterified estrogens with biennis), 24, 301 methyltestosterone), 20, 122 Evista (raloxifene), 13, 242 350 Index

Exelon (rivastigmine), 10, 248 Ferrlecit (ferrous gluconate complex), Exemestane (Aromasin), 5, 130 11, 133 Exenatide (Byetta), 130 Ferrous Gluconate (Fergon), 133 Exjade (deferasirox), 1, 96 Ferrous Gluconate Complex (Ferrlecit), Expectorants, 22 11, 133 Exsel Shampoo (selenium sulfide), Ferrous sulfate (OTC), 11, 134 11, 252 Feverfew (Tanacetum parthenium), Exubera (insulin human inhalation 24, 301 powder), 163 Fexofenadine (Allegra, Allegra-D), Eye (ophthalmic) agents, classification 1, 134 of, 13, 14 Filgrastim [G-CSF] (Neupogen), 17, 134 Ezetimibe (Zetia), 8, 130 Finasteride (Proscar, Propecia), 11, 23, /simvastatin (Vytorin), 130 134 Fioricet (acetaminophen with butalbital Factive (gemifloxacin), 2, 145 w/wo caffeine), 21, 27 Factrel, 20 Fiorinal (aspirin and butalbital Famciclovir (Famvir), 6, 130 compound), 21, 47 Famotidine (Pepcid, Pepcid AC), Fiorinal with Codeine (aspirin with 15, 130 butalbital, caffeine, and codeine), Famvir (Famciclovir), 6, 130 21, 48 Faslodex (fulvestrant), 5, 143 Fish Oil (Omacor, OTC), 11 Feldene (piroxicam), 22, 231 supplements, 24, 301 Felodipine (Plendil), 7, 131, 327 Flagyl (metronidazole), 3, 11, 193 Femara (letrozole), 5, 174 Flamp (fludarabine phosphate), 4, 136 FemconFe, 318 Flavoxate (Urispas), 23, 135 FemHRT (norethindrone acetate/ethinyl Flecainide (Tambocor), 7, 135, 326, 327 estradiol), 20, 123 Flexeril (cyclobenzaprine), 19, 89 Feminone (ethinyl estradiol), 126, 318, Flolan (Epoprostenol), 8, 118 319, 320, 321, 322 Flomax (tamsulosin), 23, 266 Fenofibrate (TriCor, Antara, Lofibra, Flonase (fluticasone, oral, nasal), 23, 139 Lipofen, Triglide), 8, 131 Florinef (fludrocortisone acetate), Fenoldopam (Corlopam), 8, 131 12, 136 Fenoprofen (Nalfon), 22, 131 Flovent, Flovent Rotadisk (fluticasone, Fentanyl (Sublimaze), 21, 132, 328 oral, nasal), 23, 139 iontophoretic transdermal system Floxin (ofloxacin), 2, 14, 211 (Ionsys), 21, 132 Floxuridine (FUDR), 4, 135 Transdermal (Duragesic), 21, 132 Fluarix (influenza vaccine), 18, 162 Transmucosal (Actiq, Fentora), 21 Fluconazole (Diflucan), 3, 136, 327, 328 Transmucosal System (Actiq, Fludarabine phosphate (Flamp, Fludara), Fentora), 21, 133 4, 136 Fentora, 21, 133 Fludrocortisone Acetate (Florinef), Fergon (ferrous gluconate), 133 12, 136 Index 351

Flulaval (influenza vaccine), 18, 162 Foscavir (foscarnet), 6, 142 Flumadine (rimantadine), 6, 246 Fosfomycin (Monurol), 3, 142 Flumazenil (Romazicon), 1, 136 Fosinopril (Monopril), 6, 142 FluMist (Influenza virus vaccine live, Fosphenytoin (Cerebyx), 9, 142 intranasal), 18, 162 Fosrenol (lanthanum carbonate), Flunisolide (AeroBid, Aerospan, 24, 173 Nasarel), 23, 137 Fragmin (dalteparin), 16, 93 Fluocinolone, 314 Frova (Frovatriptan), 21, 143 Fluoroquinolones, classification of, 2 Frovatriptan (Frova), 21, 143 Fluorouracil FUDR (Floxuridine), 4, 135 [4-FU] (Adrucil), 4, 137 Fulvestrant (Faslodex), 5, 143 topical (4-FU) (Efudex), 137 Fungizone (Amphotericin B), 3, 10 Fluoxetine (Prozac, Sarafem), 9, 137, Furadantin (nitrofurantoin), 208 327 Furosemide (Lasix), 8, 143 Fluoxymesterone (Halotestin, Androxy), Fuzeon (enfuvirtide), 6, 115 5, 12, 138 Fluphenazine (Prolixin, Permitil), 138 Gabapentin (Neurontin), 9, 144 Flurandrenolide, 315 Gabitril (tiagabine), 9, 274 Flurazepam (Dalmane), 10, 138 Galantamine (Razadyne), 10, 144 Flurbiprofen (Ansaid, Ocufen), 22, 139 Gallium nitrate (Ganite), 13, 144 Flutamide (Eulexin), 5, 139 Gamimune N (immune globulin IV), Fluticasone 18, 160 Oral, Nasal (Flonase, Flovent, Flovent Gammar IV (immune globulin IV), Rotadisk), 23, 139 18, 160 Propionate and Salmeterol Xinafoate Ganciclovir (Cytovene, Vitrasert), 6, 144 (Advair Diskus, Advair HFA), Ganite (Gallium nitrate), 13, 144 23, 140, 315 Garamycin (gentamicin), 1, 11, 14, 146 Fluvastatin (Lescol), 8, 140 Gardasil (human papillomavirus Fluvirin (influenza vaccine), 18, 162 recombinant vaccine), 240 Fluvoxamine (Luvox), 9, 140, 327, 328 Garlic (Allium sativum), 24, 301 Fluzone (influenza vaccine), 18, 162 Gastrointestinal agents, classification Folex (methotrexate), 4, 19 of, 15, 16 Folic acid, 11, 140 Gaviscon (Alginic Acid, aluminum Fondaparinux (Arixtra), 16, 141 hydroxide and magnesium Foradil Aerolizer (formoterol), 22, 141 trisilicate), 15 Formoterol (Foradil Aerolizer), 22, 141 Extra Strength, liquid (aluminum Fortaz (ceftazidime), 2, 72 hydroxide and magnesium Forteo (teriparatide), 13, 270 carbonate), 36 Fortovase (saquinavir), 6, 250, 328 Gefitinib (Iressa), 5, 145 Fosamax (alendronate), 13, 32 Gemcitabine (Gemzar), 4, 145 Fosamprenavir (Lexiva), 6, 141 Gemfibrozil (Lopid), 8, 145 Foscarnet (Foscavir), 6, 142 Gemifloxacin (Factive), 2, 145 352 Index

Gemtuzumab ozogamicin (Mylotarg), Glycerin Suppository, 16, 149 5, 146 Glynase (glyburide), 12, 148 Gemzar (gemcitabine), 4, 145 Glyset (miglitol), 12, 195 Generlac (lactulose), 16, 172 G-Mycitin (Garamycin, Gentamicin), Gengraf (cyclosporine), 18, 90, 328 1, 11, 146 Genoptic (gentamicin, ophthalmic), GoLYTELY (polyethylene glycol- 14, 147 electrolyte solution), 16, 232 Gentacidin (gentamicin, ophthalmic), Gonadorelin (Lutrepulse), 20, 149 14, 146 Goserelin (Zoladex), 5, 149 Gentak (gentamicin, ophthalmic), 14, 147 Granisetron (Kytril), 15, 149 Gentamicin (Garamycin, G-Mycitin), Green tea (Camellia sinensis), 24, 303 1, 11, 146 Guaifenesin (Robitussin), 22, 150 Ophthalmic (Garamycin, Genoptic, and Codeine (Robitussin AC, Gentacidin, Gentak), 14, 146 Brontex), 22, 150 and Prednisolone, Ophthalmic and Dextromethorphan, 22, 150 (Pred-G Ophthalmic), 146 Guarana (Paullinia cupana), 24, 303 Gentian (Gentiana lutea), 24, 302 Geodon (ziprasidone), 10, 293 Habitrol (nicotine transdermal), 24 Ginger (Zingiber officinale), 24, 302 Haemophilus B Conjugate Vaccine Ginkgo Biloba, 24, 302 (ActHIB, HibTITER, Pedvax-HIB, Ginseng, 24, 302 Prohibit), 18, 150 Glaucoma agents, 13 Halcinonide, 315 Gleevec (imatinib), 5, 159 Halcion (triazolam), 10, 283, 327 Gliadel (carmustine [BCNU]), 4, 67 Haldol (haloperidol), 10, 150, 327 Glimepiride (Amaryl), 12, 147 Halobetasol, 315 /pioglitazone (Duetact), 12, 147 Haloperidol (Haldol), 10, 150, 327 Glipizide (Glucotrol), 12, 147 Halotestin (fluoxymesterone), 5, 12, 138 Glucagon, 12, 148 Havrix (hepatitis A vaccine), 18, 152 Glucocorticoids, 328 Hawthorn (Crataegus laevigata), 24, 304 Glucophage (metformin), 12, 189 H-BIG (hepatitis B immune globulin), Glucophage XR (metformin), 12, 189 18, 152 Glucosamine Sulfate (chitosamine), Hematologic agents, classification of, 16, 24, 303 17 and Chondroitin Sulfate, 24 Hematopoietic stimulants, 17 Glucotrol, Glucotrol XL (Glipizide), Heparin, 16, 151 12, 147 Hepatitis A (Inactivated) and Hepatitis B Glucovance (glyburide/metformin), Recombinant Vaccine (Twinrix), 18, 12, 148 152 Glu-K, 323 Hepatitis A Vaccine (Havrix, Vaqta), 18, Glyburide (DiaBeta, Micronase, 152 Glynase), 12, 148 Hepatitis B Immune Globulin /Metformin (Glucovance), 12, 148 (HyperHep, H-BIG), 18, 152 Index 353

Hepatitis B vaccine (Engerix-B, and Aspirin (Lortab ASA), 21, 154 Recombivax HB), 18, 152 and caffeine (Hycomine), 22, 155 Hepsera (adefovir), 6, 29 with chlorpheniramine, 22, 155 Herbal agents, 24 Chlorpheniramine, Phenylephrine, with known toxicity, 307 Acetaminophen, and Caffeine Herceptin (trastuzumab), 5, 281 (Hycomine), 22, 155 Hespan (hetastarch), 17, 152 and Guaifenesin (Hycotuss Hetastarch (Hespan), 17, 152 Expectorant), 22, 154 Hexalen (altretamine), 4, 35 and Homatropine (Hycodan, HibTITER (haemophilus B conjugate Hydromet), 22, 155 vaccine), 18, 150 and Ibuprofen (Vicoprofen), 21, 155 Hiprex (methenamine), 23, 189 phenylephrine, 22 Histussin-D (hydrocodone and and Pseudoephedrine (Detussin, pseudoephedrine), 22, 155 Histussin-D), 22, 155 Holoxan (ifosfamide), 4, 158, 328 and pseudoephedrine (Detussin, Hormones, 5 Histussin-D), 22 and synthetic substitutes, 12 Hydrocortisone (Solu-Cortef, Horsetail (Equisetum arvense), 24, 304 Hydrocortone), 315 Human Papillomavirus (Types 6, 11, 16, Rectal (Anusol-HC Suppository, 18) Recombinant Vaccine Cortifoam Rectal, Proctocort), (Gardasil), 18, 152 16, 155 Humira (Adalimumab), 17, 29 Topical and Systemic (Cortef, Hycamtin (topotecan), 5, 280 Solu-Cortef), 12, 155, 313 Hycodan (hydrocodone and HydroDIURIL (hydrochlorothiazide), homatropine), 12, 155 8, 153 Hycomine (hydrocodone, Hydromet (hydrocodone and chlorpheniramine, phenylephrine, homatropine), 12, 155 acetaminophen,and caffeine), Hydromorphone (Dilaudid), 21, 156 7, 22, 155 Hydroxocobalamin (Cyanokit), 1, 156 Hycotuss Expectorant (hydrocodone and Hydroxyurea (Hydrea, Droxia), 5, 156 guaifenesin), 22, 154 Hydroxyzine (Atarax, Vistaril), Hydralazine (Apresoline), 8, 153 1, 9, 10, 156 Hydrea (hydroxyurea), 5, 156 Hygroton (chlorthalidone), 8, 78 Hydrochlorothiazide (HydroDIURIL, Hyoscyamine (Anaspaz, Cystospaz, Esidrix), 8, 153 Levsin), 16, 23, 157 and Amiloride (Moduretic), 8, 153 Hyoscyamine, Atropine, and Spironolactone (Aldactazide), 8, 154 Scopolamine,and Phenobarbital and Triamterene (Dyazide, Maxzide), (Donnatal), 16, 157 8, 154 Hypercalcemia/osteoporosis agents, 13 Hydrocodone, 327 HyperHep (hepatitis B immune and Acetaminophen (Lorcet, Vicodin, globulin), 18, 152 Hycet), 21, 154 Hytrin (terazosin), 6, 23, 269 354 Index

Ibandronate Sodium (Boniva), 13, 157 Infasurf (calfactant), 23, 65 Ibuprofen (Motrin, Rufen, Advil), InFeD (iron dextran), 11, 166 22, 158 Infergen (interferon alfacon-I), 17, 164 /oxycodone (Combunox), 218 Infliximab (Remicade), 16, 162 Ibutilide (Corvert), 7, 158 Influenza vaccine (Fluarix, Flulaval, Idamycin (Idarubicin), 4, 158 Fluzone, Fluvirin), 18, 162 Idarubicin (Idamycin), 4, 158 Influenza Virus Vaccine Live, Intranasal Ifex (ifosfamide), 4, 158, 328 (FluMist), 18, 162 Ifosfamide (Ifex, Holoxan), 4, 158, 328 Infumorph (morphine), 21, 198, 329 Ilopan (dexpanthenol), 16, 98 INH (Isoniazid), 4, 167, 327 Ilopan-choline Oral (dexpanthenol), Innohep (tinzaparin), 16, 276 16, 98 Inocor (inamrinone), 8, 161 Iloprost (Ventavis), 8, 159 Inotropic/pressor agents, 8 Ilotycin Ophthalmic (erythromycin, Inspra (Eplerenone), 6, 117 ophthalmic), 2, 119, 120 Insulin Imatinib (Gleevec), 5, 159 human inhalation powder (Exubera), Imdur (isosorbide mononitrate), 8, 168 163 Imipenem-Cilastatin (Primaxin), 2, 159 injectable, 163 Imipramine (Tofranil), 9, 22, 160, 326, Systemic, 12, 317 327 Intal (cromolyn sodium), 1, 23, 88 Imiquimod cream, 4% (Aldara), 11, 160 Integrilin (eptifibatide), 17, 118 Imitrex (sumatriptan), 21, 264 Interferon Immune Globulin Alfa (Roferon-A, Intron A), 17, 163 IV (Gamimune N, Sandoglobulin, Alfa-2b and Ribavirin Combo Gammar IV), 18, 160 (Rebetron), 6, 164 Subcutaneous (Vivaglobin), 18, 160 Alfacon-I (Infergen), 17, 164 Immune system agents, classification Beta 1a (Rebif), 10, 165 of, 17 Beta-1b (Betaseron), 17, 165 Immunomodulators, 17 Gamma-1b (Actimmune), 17, 165 Immunosuppressive agents, 18 Interleukin-2 (Proleukin, Aldesleukin, Imodium (Loperamide), 15, 180 IL-2), 6, 31 Imuran (azathioprine), 18, 52 Intron A (interferon alfa), 17, 163 Inactivated poliovirus (IPV) (Pediarix), Intropin (dopamine), 8, 107 18, 104 Invanz (Ertapenem), 2, 119 Inamrinone [Amrinone] (Inocor), 8, 161 Invirase (saquinavir), 4, 250, 328 Inapsine (droperidol), 15, 109 Iopidine (apraclonidine), 13, 45 Increlex (mecasermin), 24, 184 Ipecac Syrup, 1, 165 Indapamide (Lozol), 8, 161 Ipratropium (Atrovent HFA, Atrovent Inderal (propranolol), 7, 239, 327 Nasal), 23, 166 Indinavir (Crixivan), 6, 161, 328 Irbesartan (Avapro), 7, 166 Indocin (indomethacin), 22, 161 Iressa (gefitinib), 5, 145 Indomethacin (Indocin), 22, 161 Irinotecan (Camptosar), 5, 166 Index 355

Iron dextran (DexFerrum, InFeD), Keflex (cephalexin), 2, 74 11, 166 Kefzol (cefazolin), 2, 69 Iron sucrose (Venofer), 11, 166 Kepivance (palifermin), 24, 219 Ismo (isosorbide mononitrate), 8, 168 Keppra (Levetiracetam), 9, 175 Isoniazid (INH), 4, 167, 327 Kerlone (betaxolol), 7, 56 Isoproterenol (Isuprel), 8, 22, 167 Ketek (telithromycin), 2, 267, 328 Isoptin (verapamil), 7, 289, 326, Ketoconazole (Nizoral, Nizoral AD 327, 328 Shampoo), 3, 11, 169, 327, 328 Isopto Atropine, generic, 51 Ketolide, classification of, 2 Isosorbide dinitrate (Isordil, Sorbitrate, Ketoprofen (Orudis, Oruvail), Dilatrate-SR), 8, 167 22, 170 and hydralazine HCL (BiDil), 168 Ketorolac (Toradol), 22, 170 Isosorbide mononitrate (Ismo, Imdur), Ophthalmic (Acular, Acular LS, 8, 168 Acular PF), 14, 171 Isotretinoin [13-cis retinoic acid] Ketotifen (Zaditor), 14, 171 (Accutane, Amnesteem, Claravis, Kineret (anakinra), 17, 43 Sotret), 11, 168 Klonopin (Clonazepam), 9, 84 Isradipine (DynaCirc), 7, 169 K-Lor (potassium supplements), 323 Isuprel (isoproterenol), 8, 22, 167 Klorvess (potassium supplements), Itraconazole (Sporanox), 3, 169, 328 323 Klotrix, 323 Januvia (sitagliptin phosphate), 12, 255 K-Lyte, 323 Jolivette, 321 K-Tab, 323 Junel Fe, 318 Kunecatechins (Veregen), 11, 171 Juniper, 307 Kwell (lindane), 11, 178 Kytril (granisetron), 15, 149 Kabikinase (streptokinase), 17, 261 Kadian SR (morphine), 21, 198 Labetalol (Trandate, Normodyne), Kaletra (ritonavir/lopinavir), 6, 180 7, 171 Kaochlor (potassium supplements), 323 Lac-Hydrin (lactic acid and ammonium Kaodene (kaolin-pectin), 15, 169 hydroxide [ammonium lactate]), Kaolin-Pectin (Kaodene, Kao-Spen, 11, 171 Kapectolin, Parepectolin), 169 Lactic acid and ammonium hydroxide Kaon (potassium supplements), 323 [ammonium lactate] (Lac-Hydrin), Kao-Spen (kaolin-pectin), 15, 169 11, 171 Kapectolin (kaolin-pectin), 15, 169 Lactinex Granules (Lactobacillus), Kariva, 318 15, 171 Kava Kava (Kava Kava Root Extract, Lactobacillus (Lactinex Granules), Piper methysticum), 24, 304, 307 15, 171 KayCiel, 323 Lactulose (Constulose, Generlac, Kayexalate (sodium polystyrene Chronulac, Cephulac, Enulose), sulfonate), 24, 257 16, 172 356 Index

Lamictal (lamotrigine), 9, 172 Levo-Dromoran (levorphanol), 21, 176 Lamisil (terbinafine), 3, 11, 270 Levofloxacin (Levaquin, Quixin and Lamivudine (Epivir, Epivir-HBV), Iquix Ophthalmic), 2, 13, 176 6, 172 Levonorgestrel (Plan B), 19, 176, 318, and Zidovudine (Combivir), 4, 293 319, 320, 321, 322 Lamotrigine (Lamictal), 9, 172 Levonorgestrel intrauterine device (IUD) Lanoxicaps (digoxin), 7, 8, 102 (Mirena), 19, 176 Lanoxin (digoxin), 7, 8, 102 Levophed (norepinephrine), 8, 209 Lansoprazole (Prevacid, Prevacid IV), Levora, 318 15, 172, 327 Levorphanol (Levo-Dromoran), 21, 176 Lanthanum Carbonate (Fosrenol), Levothyroxine (Synthroid, Levoxyl), 13, 24, 173 177 Lapatinib (Tykerb), 173 Levoxyl (levothyroxine), 13, 177 Lasix (furosemide), 8, 143 Levsin (hyoscyamine), 16, 23, 157 Latanoprost (Xalatan), 13, 173 Lexapro (escitalopram), 9, 120 Laxatives. See Cathartics/Laxatives Lexiva (fosamprenavir), 6, 141 Leflunomide (Arava), 19, 173 Lialda (mesalamine), 16, 187 Lenalidomide (Revlimid), 17, 173 Libritabs (chlordiazepoxide), 9, 76 Lepirudin (Refludan), 16, 174 Librium (chlordiazepoxide), 9, 76 Lescol (fluvastatin), 8, 140 Licorice (Glycyrrhiza glabra), 24, Lessina, 318 304, 307 Letrozole (Femara), 5, 174 Lidocaine (Anestacon Topical, Leucovorin (Wellcovorin), 5, 174 Xylocaine), 177, 312, 326 Leukeran (Chlorambucil), 4, 76 and Prilocaine (EMLA, LMX), 7, 21, Leukine (sargramostim [GM-CSF]), 251 178 Leuprolide (Lupron, Lupron DEPOT, Lidocaine/Tetracaine Transdermal Lupron DEPOT-Ped, Viadur, (Synera), 178 Eligard), 5, 20, 174 Lidocaine/Tetracaine (Synera), 177 Leustatin (cladribine), 5, 82 Life root, 307 Levalbuterol (Xopenex, Xopenex HFA), Lindane (Kwell), 11, 178 22, 175 Linezolid (Zyvox), 3, 178, 329 Levamisole (Ergamisol), 5 Lioresal (Baclofen), 19, 53 Levaquin (Levofloxacin, Quixin Liothyronine (Cytomel), 13, 179 Ophthalmic), 2, 13, 176 Lipid-lower/antihypertensive combos, 8 Levatol (penbutolol), 7, 223 Lipid-lowering agents, 8 Levetiracetam (Keppra), 9, 175 Lipitor (Atorvastatin), 8, 50, 328 Levitra (vardenafil), 24, 288, 328 Liposomal (DepoDur), 21, 198 Levlen, 318 Liqui-Char Activated (charcoal, Levlite, 318 activated), 1, 75 Levobunolol (A-K Beta, Betagan), 13, 175 Lisdexamfetamine (Vyvanse), Levocabastine (Livostin), 13, 175 10, 11, 179 Levodopa (carbidopa), 9, 66 Lisinopril (Prinivil, Zestril), 6, 179 Index 357

Lithium, 329 Lucentis (Ranibizumab), 243 carbonate (Eskalith, Lithobid), 10, 179 Lunelle (estradiol cypionate and Lithobid (lithium carbonate), 10, 179 medroxyprogesterone acetate), Livostin (Levocabastine), 13, 175 19, 123 LMX (lidocaine and prilocaine), Lunesta (Eszopiclone), 10, 125 7, 21, 178 Lupron (leuprolide), 5, 20, 74 Local anesthetics, 21, 312 Lutrepulse (gonadorelin), 20, 149 Lodoxamide (Alomide), 13, 14, 180 Lutropin Alfa (Luveris), 20, 182 Loestrin Fe, 318, 322 Luveris (lutropin alfa), 20, 182 Lomefloxacin (Maxaquin), 2, 180 Luvox (fluvoxamine), 9, 140, 327, 328 Lomotil (diphenoxylate with atropine), Lybrel, 322 15, 104 Lymphocyte Immune Globulin Loniten (minoxidil), 8, 11, 195 [Antithymocyte Globulin, ATG] Lo/Ovral, 319 (Atgam), 18, 182 Loperamide (Imodium), 15, 180 Lyrica (pregabalin), 22, 235 Lopid (gemfibrozil), 8, 145 Lysergic acid diethylamide (LSD), 329 Lopinavir/Ritonavir (Kaletra), 6, 180 Lopressor (metoprolol), 7, 193 Maalox (aluminum hydroxide with Loprox (ciclopirox), 11, 79 magnesium hydroxide), 15, 36 Lopurin (allopurinol), 19, 33 Maalox Plus (aluminum hydroxide with Lorabid (loracarbef), 2, 181 magnesium hydroxide and Loracarbef (Lorabid), 2, 181 simethicone), 15, 36 Loratadine (Claritin, Alavert), 1, 181 Macrobid (nitrofurantoin), 23, 208 Lorazepam (Ativan), 9, 181 Macrodantin (nitrofurantoin), 23, 208 Lorcet (hydrocodone and Macrolides antibiotics, 328 acetaminophen), 21, 154 Macrolides, classification of, 2 Lortab ASA (Hydrocodone and aspirin), Magaldrate (Riopan, Lowsium), 21, 154 15, 183 Losartan (Cozaar), 7, 182 Magnesium Citrate, 16, 183 Lotensin (Benazepril), 6, 55 Magnesium Hydroxide (Milk of Lotrimin (clotrimazole), 3, 85 Magnesia), 16, 183 Lotrisone (clotrimazole and beta- Magnesium Oxide (Mag-Ox 400), 11, 183 methasone), 3, 11, 86 Magnesium Sulfate, 11, 20, 183 Lotronex (alosetron), 16, 33 Magnesium trisilicate, alginic acid and Lovastatin (Mevacor, Altocor), aluminum hydroxide with 8, 182, 328 (Gaviscon), 15, 32, 37 Lovenox (enoxaparin), 16, 115 Mag-Ox 400 (magnesium oxide), 11, 183 Low-Ogestrel, 319 Ma huang/ephedra, 24, 301, 307 Lowsium (magaldrate), 15, 183 Malarone (atovaquone/proguanil), 6, 50 Lozol (indapamide), 8, 161 Mannitol, 8, 184 L-PAM (melphalan), 4, 185 Marcaine (bupivacaine), 21, 61, 312 Lubiprostone (Amitiza), 16, 182 Marinol (dronabinol), 15, 110 358 Index

Matulane (procarbazine), 4, 236 Meridia (sibutramine), 13, 253, 329 Mavik (trandolapril), 6, 281 Meropenem (Merrem), 2, 187 Maxair (pirbuterol), 22, 231 Merrem (Meropenem), 2, 187 Maxaquin (lomefloxacin), 2, 180 Mesalamine (Asacol, Lialda, Pentasa, Maxipime (cefepime), 2, 70 Rowasa), 16, 187 Maxitrol (neomycin, polymyxin B, and Mesna (Mesnex), 1, 188 dexamethasone), 14, 204 Mesnex (mesna), 1, 188 Maxzide (hydrochlorothiazide and Mesoridazine (Serentil), 188 triamterene), 8, 154 Mestranol, 319 Measles, Mumps, Rubella, and Varicella Metamucil (psyllium), 16, 240 Virus Vaccine Live [MMRV] Metaprel (metaproterenol), 22, 188 (ProQuad), 18, 184 Metaproterenol (Alupent, Metaprel), Mecasermin (Increlex), 24, 184 22, 188 Mechlorethamine (Mustargen), 4, 184 Metaxalone (Skelaxin), 19, 188 Meclizine (Antivert), 15, 185 Metformin (Glucophage, Glucophage Medigesic (acetaminophen with XR), 12, 189 butalbital w/wo caffeine), 21, 27 Metformin/glyburide (Glucovance), Mediquell (dextromethorphan), 22, 99, 329 12, 148 Medroxyprogesterone (Provera, Metformin/pioglitazone (ActoPlus Met), Depo-Provera), 19, 20, 185 12, 230 Mefoxin (cefoxitin), 2, 71 Metformin/rosiglitazone (avandamet), 249 Megace (megestrol acetate), 5, 24, 185 Metformin/Sitagliptin (Janumet), 12, 255 Megestrol acetate (Megace), 5, 24, 185 Methadone (Dolophine), 21, 189 Melatonin, 24, 304 Methenamine (Hiprex, Urex), 23, 189 Mellaril (thioridazine), 10, 273, 327 Methergine (methylergonovine ), 21, 191 Meloxicam (Mobic), 22, 185 Methimazole (Tapazole), 13, 190 Melphalan [L-PAM] (Alkeran), 4, 185 Methocarbamol (Robaxin), 19, 190 Memantine (Namenda), 10, 186 Methotrexate (Rheumatrex), 4, 19 Menest (Esterified estrogens, Estratab), Methotrexate (Rheumatrex Dose Pack, 20, 121 Trexall), 190 Meningococcal Conjugate Vaccine 4 Methoxy-amphetamine, 327 (Menactra), 18 Methyldopa (Aldomet), 7, 191 Meningococcal Polysaccharide Vaccine Methylenedioxymethamphetamine (Menomune A/C/Y/W-135)), 18, 186 (ecstasy), 329 Menomune (meningococcal Methylergonovine (Methergine), 21, 191 polysaccharide vaccine), 18, 186 Methylphenidate, 329 Meperidine (Demerol), 21, 186, 329 Oral (Concerta, Ritalin, Ritalin-SR Mepivacaine (Carbocaine), 312 others), 10 Meprobamate (Equanil, Miltown), 9, 187 Transdermal (Daytrana), 10, 191 Mepron, 6 Methylprednisolone (Solu-Medrol), Mercaptopurine [6-MP] (Purinethol), 12, 192, 313 4, 187 acetate (Depo-Medrol), 313 Index 359

Metoclopramide (Reglan, Clopra, Mircette, 319 Octamide), 15, 16, 192 Mirena (IUD), 19 Metolazone (Mykrox, Zaroxolyn), 8, 192 Mirtazapine (Remeron, Remeron Metoprolol (Lopressor, Toprol XL), 7, SolTab), 9, 196, 329 193, 327 Misoprostol (Cytotec), 16, 196 MetroGel (metronidazole), 3, 11, 193 Mitomycin (Mutamycin), 4, 196 Metronidazole (Flagyl, MetroGel), Mitotic inhibitors, 5 3, 11, 193 Mitoxantrone (Novantrone), 5, 197 Mevacor (lovastatin), 8, 182, 328 Mitran (chlordiazepoxide), 9, 76 Mexiletine (Mexitil), 7, 193, 326, 327 Moban (molindone), 10, 197 Mexitil (mexiletine), 7, 193, 326, 327 Mobic (meloxicam), 22, 185 Micardis (telmisartan), 7, 267 Modafinil (Provigil), 197 Miconazole (Monistat), 3, 11, 20, 194 Modicon, 319 Miconazole/Zinc Oxide/Petrolatum Moduretic (hydrochlorothiazide and (Vusion), 11, 194 amiloride), 8, 153 Microgestin Fe, 319 Moexipril (Univasc), 6, 197 Micro-K (potassium supplements), 323 Molindone (Moban), 10, 197 Micronase (glyburide), 12, 148 Mometasone furoate, 316 Micronor, 321 Monistat (Miconazole), 3, 11, 20, 194 Midamor (Amiloride), 8, 38 Monoclate (antihemophilic Midazolam (Hypnovel, Versed), factor VIII), 45 10, 194, 327 Monoclonal antibodies, 5 Mifeprex (Mifepristone [RU-486]), MonoNessa, 319 20, 194 Monopril (fosinopril), 6, 142 Mifepristone [RU-486] (Mifeprex), Montelukast (Singulair), 1, 23, 198 20, 194 Monurol (fosfomycin), 3, 142 Miglitol (Glyset), 12, 195 Morphine (Avinza XR, Duramorph, Migraine headache medications, 21 Infumorph, MS Contin, Kadian SR, Milk of Magnesia (Magnesium Oramorph SR, Infumorph, hydroxide), 16, 183 Palladone, Roxanol), 21, 198, 329 Milk Thistle (Silybum marianum), Liposomal (DepoDur), 21, 198 24, 305 Motrin (ibuprofen), 22, 158 Milrinone (Primacor), 8, 195 Moxifloxacin (Avelox, Vigamox), Miltown (Meprobamate, Equanil), 2, 198 9, 187 MS Contin (morphine), 21, 198 Mineral Oil, 16, 195 Mucomyst (Acetadote, acetylcysteine), Minipress (prazosin), 6, 235 1, 22, 23, 28 Minocycline (Solodyn), 11, 195 Multivitamins, 11, 199, 330 Minoxidil (Loniten, Rogaine), 8, 11, 195 Mupirocin (Bactroban), 11, 199 MiraLax (polyethylene glycol 3350), Muromonab-CD3 (Orthoclone OKT3), 233 18, 199 Mirapex (pramipexole), 9, 234 Muscle relaxants, 19 360 Index

Musculoskeletal agents, classification Naltrexone (Depade, Re Via, Vivitrol), of, 19 24, 201 Muse (alprostadil, urethral suppository), Namenda (memantine), 10, 186 23, 35 NAPamide (disopyramide), 7, Mustargen (mechlorethamine), 4, 184 105, 326 Mutamycin (mitomycin), 4, 196 Naphazoline (Albalon, AK-Con, Myambutol (Ethambutol), 4, 126 Naphcon), 14, 201 Mycelex (clotrimazole), 3, 85 and Pheniramine acetate (Naphcon A), Myciguent (neomycin sulfate), 11, 205 14, 201 Mycobutin (rifabutin), 4, 245, 328 Naphcon A (naphazoline and Mycolog-II (triamcinolone and nystatin), pheniramine acetate), 14, 201 3, 283 Naprosyn (naproxen), 22, 202 Mycophenolate Mofetil (CellCept), Naproxen (Aleve, Naprosyn, Anaprox), 18, 199 22, 202 Mycophenolic acid (Myfortic), 18, 199 Naratriptan (Amerge), 21, 202 Mycostatin (nystatin), 3, 11, 20, 210 Narcan (naloxone), 1, 201 Myfortic (mycophenolic acid), 18, 199 Narcotic analgesics, 21 Mykrox (metolazone), 8, 192 Nardil (phenelzine), 9, 227 Mylanta (aluminum hydroxide with NasalCrom (cromolyn sodium), 1, 14, magnesium hydroxide and 23, 88 simethicone), 36 Nasarel (flunisolide), 23, 137 Mylanta/Mylanta II (aluminum Natalizumab (Tysabri), 10, 17, 202 hydroxide with magnesium Nateglinide (Starlix), 12, 202 hydroxide and simethicone), Natrecor (nesiritide), 8, 205 15, 36 Natural and herbal agents, 24 Myleran (busulfan), 4, 62 Navane (thiothixene), 10, 274 Mylicon (simethicone), 15, 254 Navelbine (vinorelbine), 5, 291 Mylotarg (gemtuzumab ozogamicin), Nebcin (tobramycin), 1, 277 5, 146 NebuPent (pentamidine), 6, 224 Myozyme (alglucosidase alfa), 24, 32 Necon, 319, 320 Nedocromil (Tilade), 23, 203 Nabilone (Cesamet), 15, 200 Nefazodone (Serzone), 9, 203, 328 Nabumetone (Relafen), 22, 200 Nelarabine (Arranon), 4, 203 Nadolol (Corgard), 7, 200 Nelfinavir (Viracept), 6, 203, 328 Nafcillin (Nallpen), 3, 200 Nembutal (pentobarbital), 9, 10, 225 Naftifine (Naftin), 11, 201 Neo-Calglucon (calcium glubionate), Naftin (naftifine), 11, 201 11, 64 Nalbuphine (Nubain), 21, 201 NeoDecadron Ophthalmic (neomycin Nalfon (fenoprofen), 22, 131 and dexamethasone), 14, 204 Nallpen (Nafcillin), 3, 200 Neomycin, 1 Naloxone (Narcan, Nalone, Bacitracin, and Polymyxin B Narcanti), 1, 201 (Neosporin Ointment), 203 Index 361

Colistin, and Hydrocortisone Nevanac (nepafenac), 14, 205 (Cortisporin-TC Otic Drops), Nevirapine (Viramune), 6, 205, 328 12, 203 Nexavar (sorafenib), 5, 258 Colistin, Hydrocortisone, and Nexium (Esomeprazole), 15, 121 Thonzonium (Cortisporin-TC Niacin (Niaspan, Slo-Niacin), 8, 206 Otic Suspension), 12, 203 Niaspan (niacin), 8, 206 and Dexamethasone (AK-Neo-Dex Nicardipine (Cardene), 7, 206 Ophthalmic, Neo-Dex Ophthalmic, Nicoderm (nicotine transdermal), 24 NeoDecadron Ophthalmic), 14, 204 Nicorette (nicotine gum), 24, 206 Polymyxin, and Hydrocortisone Nicotine gum (Nicorette, others), 24, 206 (Cortisporin Ophthalmic and Otic), Nicotine Nasal Spray (Nicotrol NS), 13, 204 24, 206 and Polymyxin B (Neosporin Cream), Nicotine Transdermal (Habitrol, 204 Nicoderm, Nicotrol), 24 Polymyxin B, and Dexamethasone Nicotrol (nicotine transdermal), 24, 207 (Maxitrol), 14, 204 Nicotrol NS (nicotine nasal spray), Polymyxin B, and Prednisolone 24, 206 (Poly-Pred Ophthalmic), 14, 204 Nifedipine (Procardia, Procardia XL, -Polymyxin Bladder Irrigant Adalat, Adalat CC), 7, 207, 327 (Neosporin GU Irrigant), 23, 204 Nilandron (nilutamide), 5, 207 Sulfate (Myciguent), 205 Nilutamide (Nilandron), 5, 207 Sulfate (Myciguent, Neo-Fradin, Nimodipine (Nimotop), 7, 10, 207, 327 generic), 11, 16, 205 Nimotop (nimodipine), 7, 10, 207, 327 NeOral (cyclosporine), 90 Nipride (nitroprusside), 8, 209 Neosar (cyclophosphamide), 4, 90 Niravam (alprazolam, 9, 34, 327 Neosporin GU Irrigant (neomycin- Nisoldipine (Sular), 7, 208, 327 polymyxin bladder irrigant), 23, 204 Nitazoxanide (Alinia), 4, 208 Neosporin Ointment (bacitracin, Nitro-Bid IV (nitroglycerin), 8, 208 neomycin, and polymyxin B, Nitro-Bid Ointment (nitroglycerin), topical), 10, 53, 203 8, 208 Neo-Synephrine (Phenylephrine), Nitrodisc (nitroglycerin), 8, 208 8, 227, 228 Nitrofurantoin (Macrodantin, Furadantin, Nepafenac (Nevanac), 14, 205 Macrobid), 23, 208 NePO (cyclosporine), 18 Nitrogen mustards, 4 Nesiritide (Natrecor), 8, 205 Nitroglycerin (Nitrostat, Nitrolingual, Nettle (Urtica dioica), 24, 305 Nitro-Bid Ointment, Nitro-Bid IV, Neulasta (pegfilgrastim), 17, 221 Nitrodisc, Transderm-Nitro), 8, 208 Neumega (oprelvekin), 17, 213 Nitrolingual (nitroglycerin), 8, 208 Neupogen (filgrastim [G-CSF]), 17, 134 Nitropress (nitroprusside), 8, 209 Neuromuscular blockers, 19 Nitroprusside (Nipride, Nitropress), Neurontin (gabapentin), 9, 144 8, 209 Neutrexin (trimetrexate), 6, 285 Nitrosoureas, 4 362 Index

Nitrostat (nitroglycerin), 8, 208 Nupercainal (Dibucaine), 11, 16, Nix (permethrin), 11, 226 21, 100 Nizatidine (Axid, Axid AR), 15, 209 NuvaRing (etonogestrel/ethinyl Nizoral (ketoconazole), 3, 11, 169, estradiol), 19, 129 327, 328 Nystatin (Mycostatin), 3, 11, 20, 210 Nizoral AD (ketoconazole), 3, 11, 169, 327, 328 Obesity, 13 Nonnarcotic analgesics, 21 OB/GYN agents, classification of, 19, 20 Nonsteroidal anti-inflammatory Octamide (metoclopramide), 15, 192 agents, 22 Octreotide (Sandostatin, Sandostatin Nora-BE, 321 LAR), 15, 211 Norcuron (vecuronium), 19, 289 Ocuflox Ophthalmic (Floxin, Ofloxacin), Nordette, 319 2, 13, 14, 211 Norepinephrine (Levophed), 8, 209 Ocupress Ophthalmic (carteolol), Norethindrone, 318, 319, 320, 321, 322 7, 13, 68 Acetate/Ethinyl Estradiol(Ethinyl Ofloxacin (Floxin, Ocuflox Ophthalmic), Estradiol/Norethindrone Acetate), 14, 211 20, 318, 319 Ofloxacin Ophthalmic (Floxin, Acetate/Ethinyl Estradiol Tablets, 209 Ocuflox), 2 Norflex (orphenadrine), 19, 214 Ogestrel, 319 Norfloxacin (Noroxin, Chibroxin, Olanzapine (Zyprexa, Zydis), 10, 211 Chibroxin Ophthal), 13, 209, 328 Olopatadine (Patanol), 14, 211 Norfloxacin Ophthalmic (Noroxin, Olsalazine (Dipentum), 16, 212 Chibroxin), 2 Omacor (Omega-3 fatty acid), 11 Norgestimate, 319, 320, 321 Omalizumab (Xolair), 23, 212 Norgestrel (Ovrette), 19, 210, 318, 319, Omega-3 fatty acid, 212 320, 321 Omeprazole (Prilosec, Zegerid), Norinyl, 319 15, 212, 327 Normiflo (ardeparin), 16 Omnicef (Cefdinir), 2, 69 Normodyne (labetalol), 7, 171 Omnipen (ampicillin), 3, 42 Noroxin (norfloxacin), 2, 13, 209, 328 Oncaspar (L-asparaginase), 5 Norpace (disopyramide), 7, 105, 326 Oncovin (vincristine), 5, 290, 328 Norpramin (desipramine), 9, 97 Ondansetron (Zofran), 15, 212 Nor-QD, 321 Ophthalmic agents. See Eye Nortrel, 319, 320 (ophthalmic) agents, classification of Nortriptyline (Aventyl, Pamelor), 9, 210 Ophthalmic antibiotics, 14 Norvasc (amlodipine), 7, 40 Opium, camphorated tincture of, Norvir (ritonavir), 6, 247, 328 15, 221 Novafed (pseudoephedrine), 22, 240 Oprelvekin (Neumega), 17, 213 Novantrone (mitoxantrone), 5, 197 Opticrom (cromolyn sodium), 1, 14, 23, Noxafil (posaconazole), 233 88 Nubain (nalbuphine), 21, 201 Optivar (azelastine), 1, 52 Index 363

Oral Contraceptives Oxybutynin (Ditropan, Ditropan XL), Biphasic, Monophasic, Triphasic, 216, 327 Progestin Only, 19, 213, 318 Oxybutynin (Ditropn, Ditropan XL) Extended-Cycle Combination, 19, 322 Transdermal System (Oxytrol), Multiphasic, 19, 320 23, 216, 327 Progestin Only, 19, 321 Oxycodone Oramorph SR (morphine), 21, 198 and Acetaminophen (Percocet, Tylox), Orencia (abatacept), 17, 25 21, 217 Orgaran (Danaparoid), 17 and Aspirin (Percodan, Orinase (tolbutamide), 12, 278 Percodan-Demi), 21, 217 Orlistat (Xenical, Alli [OTC]), 24, 214 Oxycodone (OxyContin, OxyIR, Orphenadrine (Norflex), 19, 214 Roxicodone), 21, 217, 327, 329 Ortho Evra (ethinyl estradiol and Oxycodone/Ibuprofen (Combunox), 218 norelgestromin), 128 OxyContin (oxycodone), 21, 217, Ortho Tri-Cyclen, 320, 321 327, 329 Ortho-Cept, 319 OxyIR (oxycodone), 21, 217 Orthoclone OKT3 (muromonab-CD3), Oxymorphone (Opana, Opana HR), 18, 199 21, 218 Ortho-Novum, 319, 321 Oxytocin (Pitocin), 20, 218 Orudis (ketoprofen), 22, 170 Oxytrol (oxybutynin transdermal Oruvail (ketoprofen), 22, 170 system), 23, 216 Orvette, 321 Oseltamivir (Tamiflu), 6, 214 Pacerone (amiodarone), 7, 39, 326, 328 Osteoporosis agents, 13 Paclitaxel (Taxol, Abraxane), 5, 219, 328 OTC Syrup (Ipecac Syrup), 1, 165 Pain medications, classification of, Otic agents, 12 21, 22 Otic Domeboro (Acetic acid and Palifermin (Kepivance), 24, 219 aluminum acetate), 12, 28 Paliperidone (Invega), 10, 219 Otobiotic Otic (polymyxin B and Palivizumab (Synagis), 6, 219 hydrocortisone), 12, 233 Palladone (morphine), 21, 198, 329 Ovcon, 320 Palonosetron (Aloxi), 15, 219 Ovral, 320 Pamelor (nortriptyline), 9, 210 Ovrette (norgestrel), 19, 210, 321 Pamidronate (Aredia), 13, 220 Oxacillin (Bactocill, Prostaphlin), Pancrease (pancrelipase, pancreatin), 3, 215 16, 220 Oxaliplatin (Eloxatin), 4, 215 Pancreatin (Pancrease, Cotazym, Creon, Oxaprozin (Daypro, Daypro ALTA), Ultrase), 16 22, 215 Pancrelipase (Pancrease, Cotazym, Oxazepam, 9, 215 Creon, Ultrase), 220 Oxcarbazepine (Trileptal), 9, 216 Pancuronium (Pavulon), 19, 220 Oxiconazole (Oxistat), 3, 11, 216 Panitumumab (Vectibix), 5, 220 Oxistat (oxiconazole), 3, 11, 216 Pantoprazole (Protonix), 15, 221, 327 364 Index

Paraflex (chlorzoxazone), 19, 78 Pentam 300 (pentamidine), 6, 224 Parafon Forte DSC (chlorzoxazone), Pentamidine (Pentam 300, NebuPent), 19, 78 6, 224 Paraplatin (carboplatin), 4, 67 Pentasa (mesalamine), 16, 187 Paregoric [Camphorated Tincture of Pentazocine (Talwin), 21, 225 Opium], 15, 221 Pentids (penicillin G, aqueous Parlodel (bromocriptine), 9, 60 [potassium or sodium]), 3, 223 Paroxetine (Paxil, Paxil CR), 9, 221, 327 Pentobarbital (Nembutal), 9, 225 Patanol (olopatadine), 14, 211 Pentosan Polysulfate Sodium (Elmiron), Pavulon (pancuronium), 19, 220 23, 225 Paxil (paroxetine), 9, 221 Pentoxifylline (Trental), 17, 225 PediaCare 1 (dextromethorphan), 22, 99 Pen-Vee K (Penicillin V, Veetids), 3, 224 Pediarix (diphtheria, tetanus toxoids, and Pepcid (famotidine), 15, 130 acellular pertussis adsorbed, Pepto-Bismol (Bismuth subsalicylate), hepatitis B (recombinant), 15, 58 inactivated poliovirus vaccine (IPV) Percocet (oxycodone and combined), 18, 104 acetaminophen), 21, 217 Pediazole (erythromycin and Percodan (oxycodone and aspirin), sulfisoxazole), 2, 120 21, 217 Pedvax-HIB (haemophilus B conjugate Percodan-Demi (oxycodone and aspirin), vaccine), 18, 150 21, 217 Peg Interferon Alfa-2b (PEG-Intron), 17 Periactin (cyproheptadine), 1, 91 Peg Intron (Peg Interferon Alfa-2b), 4, Perindopril Erbumine (Aceon), 6, 226 17, 222 Permethrin (Nix, Elimite), 11, 226 Pegasys (Peg Interferon Alfa-2a), 6, 222 Permitil (fluphenazine), 138 Pegfilgrastim (Neulasta), 17, 221 Perphenazine (Trilafon), 10, 226 Peginterferon alfa 2-b (PEG-Intron), Persantine (Dipyridamole), 17, 105 6, 222 Pethidine, 329 Peginterferon alfa-2a (Pegasys), 6, 222 Pfizerpen (penicillin G, aqueous PEG-Intron, 6 [potassium or sodium]), 3, 223 Pemetrexed (Alimta), 4, 5, 222 Phenazopyridine (Pyridium), 23, 226 Pemirolast (Alamast), 14, 223 Phenelzine (Nardil), 9, 227 Penbutolol (Levatol), 7, 223 Phenergan (promethazine), 15, 237 Penciclovir (Denavir), 6, 11, 223 Phenobarbital (Nembutal), 10, Penicillin, classification of, 3 227, 328m9 Penicillin G Phentermine, 329 aqueous (potassium or sodium) Phenylephrine, 8 (Pfizerpen, Pentids), 3, 223 cyclopentolate with (Cyclomydril), Benzathine (Bicillin), 3, 223 14, 89 Procaine (Wycillin), 3, 224 hydrocodone, chlorpheniramine, Penicillin V (Pen-Vee K, Veetids), 3, 224 acetaminophen, and caffeine with, Penlac (ciclopirox), 11, 79 22, 155 Index 365

nasal (Neo-Synephrine Nasal), 8, 227 Pneumococcal 7-Valent Conjugate ophthalmic (Neo-Synephrine Vaccine (Prevnar), 18, 232 Ophthalmic, AK-Dilate, Zincfrin), Pneumococcal Vaccine, Polyvalent 228 (Pneumovax-23), 18, 232 oral (Sudafed PE, SudoGest PE, Pneumovax-23 (pneumococcal vaccine, Nasop, Lusonal, AH-chew D, polyvalent), 18, 232 Sudafed PE quick dissolve), 228 Podocon-25 (podophyllin), 11, 232 Systemic (Neo-Synephrine), 228 Podophyllin (Podocon-25, Condylox Phenytoin (Dilantin), 9, 228, 326, 327, 328 Gel 0.4%, Condylox), 11, 232 Phos-Ex (calcium acetate), 11, 64 Pokeweed, 307 PhosLo (calcium acetate), 11, 64 Polycitra-K (potassium citrate and citric Phospholine Ophthalmic (Echothiophate acid), 23, 233 iodine), 13, 112 Polyethylene Glycol 3350 (MiraLax), 233 Phrenilin Forte (acetaminophen with Polyethylene Glycol-Electrolyte Solution butalbital w/wo caffeine), 21, 27 (GoLYTELY, CoLyte), 16, 232 Physostigmine (Antilirium), 1, 229 Polymox (amoxicillin), 3, 41 Phytonadione [Vitamin K] (Aqua- Polymyxin B and Hydrocortisone MEPHYTON), 11, 229 (Otobiotic Otic), 12, 233 Pimecrolimus (Elidel), 11, 229 Poly-Pred Ophthalmic (neomycin, Pindolol (Visken), 7, 230 polymyxin B, and prednisolone), Pioglitazone (Actos), 12, 231 14, 204 HCL/Glimepiride (Duetact), 230 Polysporin (bacitracin and polymyxin B, Pioglitazone/Metformin (ActoPlus Met), topical), 10, 14, 53 12, 230 Polysporin Ophthalmic (bacitracin and Piperacillin (Pipracil), 3, 231 polymyxin B, ophthalmic), 14, 53 Piperacillin-Tazobactam (Zosyn), 3, 231 Portia, 320 Pipracil (piperacillin), 3, 231 Posaconazole (Noxafil), 233 Pirbuterol (Maxair), 22, 231 Potassium Citrate (Urocit-K), 23, 233 Piroxicam (Feldene), 22, 231 and Citric Acid (Polycitra-K), 23, 233 Pitocin (oxytocin), 20, 218 Potassium Iodide [Lugol Solution] Pitressin (vasopressin [antidiuretic (SSKI, Thyro-Block), 13, 22, hormone, ADH]), 12, 16, 289 24, 233 Plan B (Levonorgestrel), 19, 176, 318, Potassium supplements (Kaon, Kaochlor, 319, 320, 321, 322 K-Lor, Slow-K, Micro-K, Plasma Protein Fraction (Plasmanate), Klorvess), 11, 234, 323 17, 232 Pramipexole (Mirapex), 9, 234 Plasmanate (plasma protein fraction), Pramoxine (Anusol Ointment, 17, 232 ProctoFoam-NS), 11, 16, 21, 234 Platinol/Platinol AQ (cisplatin), 4, 82 and Hydrocortisone (Enzone, Plavix (Clopidogrel), 17, 85 ProctoFoam-HC), 11, 16, 234 Plendil (felodipine), 7, 131, 327 Prandin (repaglinide), 12, 328 Pletal (cilostazol), 24, 80 Pranixine disperdose (cephalexin), 74 366 Index

Pravachol (pravastatin), 8, 235 Procaine (Novocaine), 312 Pravastatin (Pravachol), 8, 235 Procan (procainamide), 7, 236, 326 Prazosin (Minipress), 6, 235 Procarbazine (Matulane), 4, 236 Precose (Acarbose), 12, 26 Procardia (nifedipine), 7, 207, 327 Pred-G Ophthalmic (gentamicin and Procardia XL (nifedipine), 7, 207, 327 prednisolone, ophthalmic), 146 Prochlorperazine (Compazine), Prednicarbate, 316 10, 15, 237 Prednisolone (Delta-Cortef), Procrit (Epoetin alfa [erythropoietin]), 12, 235, 313 17, 117 Prednisone (Deltasone), 12, 235, 313 Proctocort (hydrocortisone, rectal), Pregabalin (Lyrica), 22, 235 16, 155 Premarin (Estrogen, conjugated), 20, 24 ProctoFoam-HC (pramoxine and with Methylprogesterone (estrogen, hydrocortisone), 11, 16, 234 conjugated with ProctoFoam-NS (pramoxine), 11, 16, methylprogesterone), 20, 125 21, 234 with Methyltestosterone (estrogen, Progesterone, 328 conjugated with Proglycem (diazoxide), 13, 100 methyltestosterone), 20, 125 Prograf (tacrolimus), 11, 18, 265 Premphase (estrogen, conjugated, and Prohibit (haemophilus B conjugate medroxyprogesterone), 20, 125 vaccine), 18, 150 Prempro (estrogen, conjugated, and Prolastin (alpha1-protease inhibitor), medroxyprogesterone), 20, 125 23, 34 Prepidil Vaginal Gel (dinoprostone), Proleukin (aldesleukin [Interleukin-2, 20, 125 IL-2]), 5, 31 Pressor agents, 8 Prolixin (fluphenazine), 138 Prevacid (lansoprazole), 15, 172, 327 Proloprim (trimethoprim), 24, 285 Prevalite (cholestyramine), 8, 79 Promethazine (Phenergan), 15, 237 Preven (ethinyl estradiol and Pronestyl (procainamide), 7, 236, 326 levonorgestrel), 19, 127 Propafenone (Rythmol), 7, 237, 326, 327 Prevnar (Pneumococcal 7-valent Propantheline (Pro-Banthine), 16, 238 conjugate vaccine), 18, 232 Propecia (finasteride), 11, 134 Prialt (ziconotide), 22, 293 Propine (dipivefrin), 13, 105 Priftin (rifapentine), 4, 246 Propofol (Diprivan), 10 Prilosec (omeprazole), 15, 212, 327 Propoxyphene (Darvon), 21, 238, 327 Primacor (milrinone), 8, 195 and Acetaminophen (Darvocet), Primaxin (imipenem-cilastatin), 2, 159 21, 238 Prinivil (lisinopril), 6, 179 and Aspirin (Darvon Compound-65, Priscoline (tolazoline), 8, 278 Darvon-N with Aspirin), 21, 238 Pro-Banthine (propantheline), 16, 238 Propranolol (Inderal), 7, 239, 327 Probenecid (Benemid), 19, 236 Propylthiouracil [PTU], 13, 239 Procainamide (Pronestyl, Pronestyl SR, ProQuad (measles, mumps, rubella, and Procanbid), 7, 236, 326 varicella virus vaccine live), 18, 184 Index 367

Proscar (finasteride), 11, 23, 134 Quinidine (Quinidex, Quinaglute), ProSom (estazolam), 10, 121 7, 241, 326, 327, 328 Prostaphlin (oxacillin), 3, 215 Quinupristin-Dalfopristin (Synercid), Prostin VR (Alprostadil [prostaglandin 3, 242 E1]), 8, 34 Quixin and Iquix Ophthalmic Protamine, 16, 239 (levofloxacin), 2, 13, 176 Protonix (pantoprazole), 15, 221 QVAR (beclomethasone), 23, 55 Protopic (tacrolimus), 11, 18, 265 Proventil (albuterol), 22, 30 Rabeprazole (AcipHex), 15, 242 Provera (medroxyprogesterone), Raloxifene (Evista), 13, 242 19, 20, 185 Ramelteon (Rozerem), 242 Provigil (modafinil), 197 Ramipril (Altace), 6, 243 Prozac (fluoxetine), 9, 137, 327 Ranexa (ranolazine), 243 Pseudoephedrine (Sudafed, Novafed, Ranibizumab (Lucentis), 243 Afrinol), 22, 240 Raniclor (cefaclor), 68 Psyllium (Metamucil, Serutan, Ranitidine Hydrochloride (Zantac), EfferSyllium), 16, 240 15, 243 Pulmicort (budesonide), 1, 16, 23, Ranolazine (Ranexa), 243 60, 328 Rapamune (sirolimus), 18, 255 Pulmozyme (dornase alfa), 23, 108 Raptiva (Efalizumab), 11, 113 Purinethol (mercaptopurine [6-MP]), Rasagiline Mesylate (Azilect), 9, 243 4, 187 Rasburicase (Elitek), 5, 244 Pyrazinamide, 4, 240 Rebetron (interferon alfa-2b and Pyridium (phenazopyridine), 23, 226 ribavirin combo), 6, 164

Pyridoxine [Vitamin B6], 11, 240 Rebif (interferon beta la), 10, 165 Reclast (zoledronic acid), 13, 294 Quadrivalent Human Papillomavirus Recombivax HB (hepatitis B vaccine), (HPV Types, 6, 11, 16, 18) 18, 152 Recombinant Vaccine Refludan (lepirudin), 16, 174 (Gardasil), 240 Reglan (metoclopramide), 15, 192 Quazepam (Doral), 241 Regranex Gel (becaplermin), 24, 55 Quelicin (Succinylcholine, Anectine, Relafen (nabumetone), 22, 200 Sucostrin), 19, 262 Relenza (Zanamivir), 6, 292 Quelicin (succinylcholine), 19, 262 Relpax (eletriptan), 21, 114 Questran (cholestyramine), 8, 79 Remeron/Remeron SolTab (mirtazapine), Quetiapine (Seroquel, Seroquel XR), 9, 196 10, 241 Remicade (infliximab), 16, 162 Quinaglute (quinidine), 7, 241, 326, Remodulin (treprostinil sodium), 8, 282 327, 328 Renagel (sevelamer), 24, 253 Quinapril (Accupril), 6, 241 Renova (tretinoin, topical [retinoic Quinidex (quinidine), 7, 241, 326, acid]), 5, 11, 282 327, 328 ReoPro (abciximab), 17, 25 368 Index

Repaglinide (Prandin), 12, 328 Risperidone (Risperdal, Risperdal Repan (acetaminophen with butalbital Consta, Risperdal M-Tab), 10, 327 w/wo caffeine), 21, 27 oral (Risperdal, Risperdal M-Tab), 247 Requip (ropinirole), 9, 249 parenteral (Risperdal Constra), 247 Rescriptor (delavirdine), 6, 96 Ritalin (methylphenidate, oral), 10, 191 Respiratory agents, classification of, Ritalin-SR (methylphenidate, oral), 22, 23 10, 191 Respiratory inhalants, 23 Ritonavir (Norvir), 6, 247, 328 Restasis (cyclosporine, ophthalmic), Ritonavir/lopinavir (Kaletra), 4, 180 13, 14, 91 Rivastigmine (Exelon), 10, 248 Restoril (temazepam), 10, 268 Rivastigmine transdermal Retapamulin (Altabax), 6, 244 (Excelon), 248 Retavase (reteplase), 17, 244 Rizatriptan (Maxalt, Maxalt Reteplase (Retavase), 17, 244 MLT), 248 Retin-A (tretinoin, topical [retinoic Robaxin (methocarbamol), 19, 190 acid]), 5, 11, 282 Robitussin (guaifenesin), 22, 150 Retinoic acid [Tretinoin, topical] Robitussin AC (guaifenesin and (Retin-A, Avita, Renova), 6, 11, 282 codeine), 22, 150 Retrovir (zidovudine), 6, 293 Rocaltrol (Calcitriol), 12, 63 Revatio (sildenafil), 23, 253, 329 Rocephin (ceftriaxone), 2, 73 ReVia (naltrexone), 24, 201 Rocuronium (Zemuron), 19, 248 Revlimid (lenalidomide), 17, 173 Roferon-A (interferon alfa), 17, 163 Reyataz (atazanavir), 6, 48, 328 Rogaine (minoxidil), 8, 11, 195 Rheomacrodex (dextran 40), 17, 98 Romazicon (flumazenil), 1, 136 Rheumatrex (methotrexate), 4, 19 Ropinirole (Requip), 9, 249 Rhinocort (budesonide), 1, 16, 23, Rosiglitazone (Avandia), 12, 249 60, 328 /Metformin (Avandamet), 249 Ribavirin (Virazole, Copegus), 6, 245 Rosuvastatin (Crestor), 8, 250 Rifabutin (Mycobutin), 4, 245, 328 RotaTeq (rotavirus vaccine, live, oral, Rifadin (rifampin), 4, 245, 327, 328 pentavalent), 18, 250 Rifampin (Rifadin), 4, 245, 327, 328 Rotavirus Vaccine, Live, Oral, Rifapentine (Priftin), 4, 246 Pentavalent (RotaTeq), 18, 250 Rifaximin (Xifaxan), 3, 246 Rowasa (mesalamine), 16, 187 Rimantadine (Flumadine), 6, 246 Roxanol (morphine), 21, 198 Rimexolone (Vexol Ophthalmic), Roxicodone (oxycodone), 21, 217 13, 14, 246 Rozerem (ramelteon), 242 Rimso 50 (dimethyl sulfoxide [DMSO]), RU-486 (mifepristone), 20, 194 23, 103 Rubex (doxorubicin), 4, 109 Riopan (magaldrate), 15, 183 Rue (Ruta graveolens), 24, 305 Risedronate (Actonel w/calcium), Rufen (ibuprofen), 22, 158 13, 246 Rythmol (Propafenone), 7, 237, Risperdal (risperidone), 10, 247, 327 326, 327 Index 369

St. John’s Wort (Hypericum perforatum), Septra (trimethoprim-sulfamethoxazole 24, 306, 328, 329 [co-trimoxazole]), 3, 285 St. Joseph’s (aspirin), 17, 21, 47 Serentil (mesoridazine), 188 Salmeterol (Serevent, Serevent Diskus), Serevent (salmeterol), 22, 250 22, 250 Serevent Diskus (salmeterol), 22 Sanctura (trospium chloride), 24, 286 Seroquel (quetiapine), 10, 241 Sandimmune (cyclosporine), 18, 90, 328 Serotonin 4-HT, receptor agonists, Sandoglobulin (immune globulin IV), 33, 107 18, 160 Sertaconazole (Ertaczo), 3, 252 Sandostatin (octreotide), 15, 211 Sertraline (Zoloft), 9, 253 Sandostatin LAR (octreotide), 15, 211 Serums, 18 Saquinavir (Fortovase, Invirase), 6, 250, Serutan (psyllium), 16, 240 328 Sevelamer (Renagel), 24, 253 Sarafem (fluoxetine), 9, 137, 327 Sibutramine (Meridia), 13, 253, 329 Sargramostim [GM-CSF] (Leukine), Sildenafil (Viagra, Revatio), 17, 251 23, 253, 328 Sassafras, 307 Silvadene (silver sulfadiazine), 11, 254 Saw Palmetto (Serenoa repens), 24, 305 Silver Nitrate (Dey-Drop), 14, Scopolamine (Scopace), 15 24, 254 ophthalmic, 14 Silver sulfadiazine (Silvadene), 11, 254 Transdermal and Ophthalmic Simethicone (Mylicon), 15, 254 (Scopace, Transderm-Scop), 251 Simulect (basiliximab), 18, 54 Seasonale (levonorgestrel/ethinyl Simvastatin (Zocor), 8, 254, 328 estradiol), 322 Sinemet (carbidopa/levodopa), 9, 66 Seasonique, 322 Sinequan (doxepin), 9, 108 Secobarbital (Seconal), 10, 251 Singulair (montelukast), 1, 23, 198 Seconal (secobarbital), 10, 251 Sirolimus (Rapamune), 18, 255 Sectral (acebutolol), 7, 26 Sitagliptin (Januvia), 12, 255 Sedapap-10 (acetaminophen with Sitagliptin/Metformin (Janumet), butalbital w/wo caffeine), 21, 27 12, 255 Sedative hypnotics, 10 Skelaxin (metaxalone), 19, 188 Selegiline, 327, 329 Slo-Niacin (niacin), 206 Oral (Eldepryl), 9, 252 Slow-K (potassium supplements), 323 Transdermal (Emsam), 9, 252 Smallpox vaccine (Dryvax), 256

Selenium sulfide (Exsel Shampoo, Sodium Bicarbonate [NaHCO3], Selsun Blue Shampoo, Selsun 11, 256 Shampoo), 11, 252 Sodium Citrate/Citric Acid (Bicitra), Selsun Blue Shampoo (selenium 23, 256 sulfide), 11, 252 Sodium Oxybate (Xyrem), 10, 257 Selsun Shampoo (selenium sulfide), Sodium Phosphate (Visicol), 16 252 Sodium Polystyrene Sulfonate Sensipar (cinacalcet), 13, 81 (Kayexalate), 24, 257 370 Index

Sodium Sulamyd (sulfacetamide), Streptomycin, 1, 4, 261 14, 263 Streptozocin (Zanosar), 4, 262 Solifenacin (VESIcare), 23, 257, 327 Striant (Testosterone), 12m271 Solu-Cortef (hydrocortisone topical and Striant (testosterone), 12, 271 systemic), 12, 155, 313 Sublimaze (Fentanyl), 21, 132, 328 Solu-Medrol (methylprednisolone), Succimer (Chemet), 1, 262 12, 192, 313 Succinylcholine (Anectine, Quelicin, Soma (carisoprodol), 19, 67 Sucostrin), 19, 262 Sonata (zaleplon), 10, 292 Sucostrin (succinylcholine), 19, 262 Sorafenib (Nexavar), 5, 258 Sucralfate (Carafate), 15, 263 Sorbitol, 16, 258 Sudafed (pseudoephedrine), 22, 240 Sorbitrate, 8 Sufentanil, 328 Sorbitrate (isosorbide dinitrate), 8, 167 Sular (nisoldipine), 7, 208, 327 Soriatane (acitretin), 10, 28 Sulfacetamide (Bleph-10, Cetamide, Sotalol (Betapace, Betapace AF), Sodium Sulamyd), 14, 263 7, 258, 326 and Prednisolone (Blephamide), Sotret (isotretinoin [13-cis retinoic 12, 14, 263 acid]), 11, 168 Sulfasalazine (Azulfidine), 263 Spectazole (econazole), 3, 11, 112 Sulfinpyrazone (Anturane), 264 Spectracef (cefditoren), 2, 70 Sulindac (Clinoril), 22, 264 Spiriva (tiotropium), 23, 277 Sumatriptan (Imitrex), 21, 264 Spironolactone (Aldactone), 8, 259 Sumycin (tetracycline), 3, 271 Spirulina (Spirulina spp), 24, 206 Sunitinib (Sutent), 5, 265 Sporanox (itraconazole), 3, 169 SuperChar (charcoal, activated), Sprintec, 320 1, 75 SSKI (potassium iodide [Lugol Supprettes (chloral hydrate), 10, 76 solution]), 13, 22, 24, 233 Suprax (cefixime), 2, 70 Stadol (butorphanol), 21, 63 Surfak (Docusate calcium), 16, 106 Starlix (nateglinide), 12, 202 Survanta (beractant), 23, 56 Stavudine (Zerit), 6, 259 Sus-Phrine (epinephrine), 8, 22, 116 Stelazine (trifluoperazine), 10, 284 Sustiva (Efavirenz), 113, 328 Sterile Talc Powder (talc), 24, 266 Sutent (sunitinib), 5, 265 Steroids Symmetrel (amantadine), 6, 9, 37 Systemic, 18, 260, 313 Synagis (palivizumab), 6, 219 Topical, 11, 314 Synera ( Lidocaine/Tetracaine Stevia (Stevia rebaudiana), 24, Transdermal), 178 306 Synercid (quinupristin-dalfopristin), Stimate (desmopressin), 12, 17, 97 3, 242 Strattera (atomoxetine), 10, 49 Synthroid (levothyroxine), 13, 177 Streptase (streptokinase), 17, 261 Streptokinase (Streptase, Kabikinase), Tabloid (6-thioguanine), 4 17, 261 Tacrine (Cognex), 10, 265 Index 371

Tacrolimus (Prograf, Protopic), Terbutaline (Brethine, Bricanyl), 11, 18, 265 20, 22, 270 Tadalafil (Cialis), 24, 265, 328 Terconazole (Terazol 7), 20, 270 Tagamet (cimetidine), 15, 80, 327 Teriparatide (Forteo), 13, 270 Talc (Sterile Talc Powder), 24, 266 Tespa (triethylenetriphosphamide), Talwin (pentazocine), 21, 225 4, 283 Tambocor (flecainide), 7, 135, Tessalon Perles (benzonatate), 22, 56 326, 327 Testim (testosterone), 12, 271 Tamiflu (oseltamivir), 6, 214 Testoderm (testosterone), 12, 271 Tamoxifen, 5, 266, 328 Testosterone (AndroGel, Androderm, Tamsulosin (Flomax), 23, 266 Striant, Testim, Testoderm), 12, 271 Tapazole (methimazole), 13, 190 Tetanus Immune Globulin, 18, 271 Tarceva (Erlotinib), 5, 118, 328 Tetanus Toxoid, 18, 271, 324 Tasmar (tolcapone), 9, 279 Tetracycline (Achromycin V, Sumycin), Tavist (clemastine fumarate), 1, 83 3, 271 Taxol (paclitaxel), 5, 19, 328 Tetracyclines, classification of, 3 Taxotere (Docetaxel), 5, 106 Teveten (eprosartan), 7, 118 Tazarotene (Tazorac, Avage), 11, 266 Thalidomide (Thalomid), 5, 272 Tazicef (ceftazidime), 2, 72 Thalomid, 5 Tazorac (tazarotene), 11, 266 Theo24 (theophylline), 22, 327 Tea tree (Melaleuca alternifolia), TheoChron (theophylline), 22, 272 24, 306 Theophylline (Theo24, TheoChron), Tears Naturale (artificial tears), 22, 272 14, 47 TheraCys (BCG [Bacillus Calmette- Tegretol (carbamazepine), 9, 65, 328 Guérin]), 5, 54 Tekturna (Aliskiren), 33 Therapeutic agents, miscellaneous, 24

Telbivudine (Tyzeka), 6, 267 Thiamine [Vitamin B1], 11, 273 Telithromycin (Ketek), 2, 267, 328 Thiethylperazine (Torecan), 15, 273 Telmisartan (Micardis), 7, 267 Thioridazine (Mellaril), 10, 273, 327 Temazepam (Restoril), 10, 268 Thio-Tepa (triethylenetriphosphamide), Temsirolimus (Torisel Kit), 5, 268 4, 283 Tenecteplase (TNKase), 17, 268 Thiothixene (Navane), 10, 274 Tenofovir (Viread), 6, 269 Thorazine (chlorpromazine), 10, 15, 77 Tenofovir/Emtricitabine (Truvada), Thyro-Block (potassium iodide), 13, 22, 6, 269 24, 233 Tenoretic (atenolol and chlorthalidone), Thyroid/antithyroid agents, 13 7, 49 Tiagabine (Gabitril), 9, 274 Tenormin (atenolol), 49 Tiamate (diltiazem), 7, 102, 326, Tensilon (Edrophonium), 19, 112 327, 328 Terazol 7 (terconazole), 20, 270 Tiazac (diltiazem), 7, 102, 326, Terazosin (Hytrin), 6, 23, 269 327, 328 Terbinafine (Lamisil), 3, 11, 270 Ticar (ticarcillin), 3, 274 372 Index

Ticarcillin (Ticar), 3, 274 Tolterodine (Detrol, Detrol LA), 24, 279, Ticarcillin/potassium clavulanate 327 (Timentin), 3, 274 Topamax (topiramate), 9, 280 Tice BCG (BCG [Bacillus Topiramate (Topamax), 9, 280 Calmette-Guérin]), 5, 54 Toposar (etoposide [VP-16]), 6, 129 Ticlid (ticlopidine), 17, 275 Topotecan (Hycamtin), 5, 280 Ticlopidine (Ticlid), 17, 275 Toprol XL (metoprolol), 7, 193 Tigan (trimethobenzamide), 15, 284 Toradol (ketorolac), 22, 170 Tigecycline (Tygacil), 3, 275 Torecan (thiethylperazine), 15, 273 Tikosyn (Dofetilide), 7, 107 Torisel Kit, 5 Tilade (nedocromil), 23, 203 Torsemide (Demadex), 8, 280 Timentin (ticarcillin/potassium Toxoids, 18 clavulanate), 3, 274 Tracrium (atracurium), 19, 50 Timolol (Blocadren), 7, 275, 327 Tramadol (Ultram, Ultram ER), Ophthalmic (Timoptic), 13, 276 21, 280, 329 Timoptic (timolol, ophthalmic), 13, 276 Tramadol/Acetaminophen (Ultracet), Tinactin (tolnaftate), 11, 279 21, 281 Tindamax (tinidazole), 4, 276 Trandate (labetalol), 7, 171 Tinidazole (Tindamax), 4, 276 Trandolapril (Mavik), 6, 281 Tinzaparin (Innohep), 16, 276 Transderm-Nitro (nitroglycerin), 8, 208 Tioconazole (Vagistat), 20, 276 Tranxene (Clorazepate), 9, 85 Tiotropium (Spiriva), 23, 277 Trastuzumab (Herceptin), 5, 281 Tipranavir (Aptivus), 277 Trasylol (aprotinin), 17, 46 Tirofiban (Aggrastat), 17, 277 Trazodone (Desyrel), 9, 282, 328 TNKase (tenecteplase), 17, 268 Trelstar Depot (triptorelin), 5, 286 TobraDex (tobramycin and Trelstar LA (triptorelin), 5, 286 dexamethasone), 14, 278 Trental (pentoxifylline), 17, 225 Tobramycin (Nebcin), 1, 277 Treprostinil Sodium (Remodulin), 8, 282 and Dexamethasone Ophthalmic Tretinoin, topical [retinoic acid] (TobraDex), 14, 278 (Retin-A, Avita, Renova, Retin-A Ophthalmic (AKTob, Tobrex), 14, 278 Micro), 5, 11, 282 Tobrex (tobramycin, ophthalmic), 14, 278 Triamcinolone (Azmacort), 23, 282, 316 Tofranil (imipramine), 9, 22, 160, and Nystatin (Mycolog-II), 3, 283 326, 327 Triamterene (Dyrenium), 8, 283 Tolazamide (Tolinase), 12, 278 Triapin (acetaminophen with butalbital Tolazoline (Priscoline), 8, 278 w/wo caffeine), 21, 27 Tolbutamide (Orinase), 12, 278 Triazolam (Halcion), 10, 283, 327 Tolcapone (Tasmar), 9, 279 TriCor (fenofibrate), 8, 131 Tolectin (tolmetin), 22, 279 Triethanolamine (Cerumenex), 12, 283 Tolinase (tolazamide), 12, 278 Triethylenetriphosphamide (Thio-Tepa, Tolmetin (Tolectin), 22, 279 Tespa, TSPA), 4, 283 Tolnaftate (Tinactin), 11, 279 Trifluoperazine (Stelazine), 10, 284 Index 373

Trifluridine, Ophthalmic (Viroptic), Tysabri (natalizumab), 10, 17, 202 13, 14, 284 Tyzeka (telbivudine), 6, 267 Trihexyphenidyl (Artane), 9, 284 Tri-K, 323 Ultracef (Duricef, Cefadroxil), 2, 69 Trilafon (perphenazine), 10, 226 Ultracet (tramadol/acetaminophen), Trileptal (oxcarbazepine), 9, 216 21, 281 Tri-Levlen, 321 Ultram (tramadol), 21, 280, 329 Trimethobenzamide (Tigan), 15, 284 Ultram ER (tramadol), 21 Trimethoprim (Trimpex, Proloprim), Ultrase (pancreatin, pancrelipase), 3, 24, 285 16, 220 Trimethoprim Sulfamethoxazole [Cotri- Unasyn (ampicillin-sulbactam), 3, 43 moxazole] (Bactrim, Septra), 3 Univasc (moexipril), 6, 197 Trimetrexate (Neutrexin), 6, 285 Unsafe herbs, 307 Trimpex (trimethoprim), 24, 285 Urecholine (bethanechol), 23, 57 Tri-Nessa, 321 Urex (methenamine), 23, 189 Tri-Norinyl, 321 Urinary/genitourinary agents, Triphasil, 321 classification of, 23 Triptans, 329 Urispas (flavoxate), 23, 135 Triptorelin (Trelstar Depot, Trelstar LA), Urocit-K (potassium citrate), 23, 233 5, 286 Urokinase (Abbokinase), 17, 286 Tri-Sprintec, 321 Uroxatral (alfuzosin), 23, 32 Trivora, 321 Usnic acid, 307 Troleandomycin, 328 Trospium Chloride (Sanctura), 24, 286 Vaccines, 18 Trusopt (dorzolamide), 13, 108 Vaginal preparations, 20 Truvada (tenofovir/emtricitabine), Vagistat (tioconazole), 20, 276 6, 269 Valacyclovir (Valtrex), 6, 286 Tryptophan, 329 Valcyte (valganciclovir), 6, 287 TSPA (triethylenetriphosphamide), Valerian (Valeriana officinalis), 24, 306 4, 283 Valganciclovir (Valcyte), 6, 287 T-Stat (erythromycin, topical), 11, 120 Valium (diazepam), 9, 19, 99, 327 Tums (calcium carbonate), 15, 64 Valproic Acid (Depakene, Depakote), Twin-K, 323 9, 287 Twinrix (hepatitis A (inactivated) and Valsartan (Diovan), 7, 287 hepatitis B recombinant vaccine), Valtrex (valacyclovir), 6, 286 18, 152 Vancenase Nasal Inhaler Two-Dyne (acetaminophen with (beclomethasone), 23, 55 butalbital w/wo caffeine), 21, 27 Vancocin (vancomycin), 3, 288 Tygacil (tigecycline), 3, 275 Vancoled (vancomycin), 3, 288 Tylenol. See Acetaminophen [APAP] Vancomycin (Vancocin, Vancoled), 3, 288 Tylox (oxycodone and acetaminophen), Vantin (cefpodoxime), 2, 72 21, 217 Vaprisol (conivaptan), 87 374 Index

Vaqta (hepatitis A vaccine), 18, 151 Vincristine (Oncovin, Vincasar PFS), Vardenafil (Levitra), 24, 288, 328 5, 290, 328 Varenicline (Chantix), 24, 288 Vinorelbine (Navelbine), 5, 291 Varicella Virus Vaccine (Varivax), 18, 288 Viracept (nelfinavir), 6, 203, 328 Varivax (varicella virus vaccine), 18, 288 Viramune (nevirapine), 6, 205, 328 Vasodilators, 8 Virazole (ribavirin), 6, 245 Vasopressin [Antidiuretic Hormone, Viread (tenofovir), 6, 269 ADH] (Pitressin), 12, 16, 289 Viroptic (trifluridine, ophthalmic), Vasotec (enalapril), 6, 114 13, 14, 284 Vectibix, 5 Visicol (sodium phosphate), 16 Vecuronium (Norcuron), 19, 289 Visken (pindolol), 7, 230 Veetids (penicillin V), 3, 224 Vistaril (hydroxyzine), 1, 9, 10, 156 Velban (vinblastine), 5, 290, 328 Vistide (Cidofovir), 6, 80

Velbe (vinblastine), 5, 290, 328 Vitamin B1 (thiamine), 291 Velcade (bortezomib), 5, 59 Vitamin B6 (pyridoxine), 291 Velivet, 321 Vitamin B12, 291 Velosef (cephradine), 2, 75 Vitamin D3 (Delta D), 11, 79 Venlafaxine (Effexor, Effexor XR), 9, Vitamin K (phytonadione), 11, 291 289, 329 Vitrasert (ganciclovir), 6, 144 Venofer (Iron sucrose), 11, 166 Vivelle (estradiol, transdermal), Ventavis (iloprost), 8, 159 20, 123 Ventolin (albuterol), 22, 30 Volmax (albuterol), 22, 30 VePesid (etoposide [VP-16]), 5, 129 Voltaren (diclofenac), 22, 100 Verapamil (Calan, Isoptin, Verelan), 7, Volume expanders, 17 289, 326, 327, 328 Voriconazole (VFEND), 3, 291, 328 Versed (Midazolam), 194 Vorinostat (Zolinza), 11, 291 VESIcare (solifenacin), 23, 257, 327 Vytorin (ezetimibe/simvastatin), 130 Vexol Ophthalmic (rimexolone), 13, 14, 246 Warfarin (Coumadin), 16, 291, 327 VFEND (voriconazole), 3, 291, 328 WelChol (colesevelam), 8, 87 Viadur (leuprolide), 5, 174 Wellbutrin (bupropion), 62 Viagra (sildenafil), 23, 253, 328 Wellcovorin (leucovorin), 5, 174 Vibramycin (doxycycline), 3, 109 Wound care agents, 24 Vicodin (hydrocodone and Wycillin (penicillin G procaine), 3, 224 acetaminophen), 21, 154 Vicoprofen (hydrocodone and Xalatan (latanoprost), 13, 173 ibuprofen), 21, 155 Xanax (alprazolam), 9, 34, 327 Videx (didanosine [ddl]), 4, 101 Xenical (orlistat), 24, 214 Vigamox (Moxifloxacin), 2, 198 Xifaxan (rifaximin), 3, 246 Vinblastine (Velban, Velbe), 5, Xigris (drotrecogin alfa), 24, 111 290, 328 Xolair (omalizumab), 23, 212 Vincasar PFS (vincristine), 5, 290, 328 Xopenex (levalbuterol), 22, 175 Index 375

Xylocaine (lidocaine), 177, 312, 326 Zinecard (dexrazoxane), 1, 98 Xyrem (sodium oxybate), 10, 257 Ziprasidone (Geodon), 10, 293 Zithromax (azithromycin), 2, 52 Yasmin, 320 Zocor (simvastatin), 8, 254, 328 YAZ (Drospirenone/ethinyl estradiol), Zofran (ondansetron), 15, 212 110, 322 Zoladex (goserelin), 5, 149 Yohimbine (Pausinystalia yohimbe), Zoledronic Acid (Zometa, Reclast), 24, 307 13, 294 Zaditor (ketotifen), 14, 171 Zolmitriptan (Zomig, Zomig XMT, Zafirlukast (Accolate), 23, 292 Zomig Nasal), 21, 294 Zaleplon (Sonata), 10, 292 Zoloft (sertraline), 9, 253 Zanamivir (Relenza), 6, 292 Zolpidem (Ambien, Ambien CR), Zanosar (streptozocin), 4, 262 10, 294 Zantac (ranitidine hydrochloride), Zometa (zoledronic acid), 13, 294 15, 243 Zomig (zolmitriptan), 21, 294 Zarontin (ethosuximide), 9, 128 Zonalon (doxepin), 11, 109 Zaroxolyn (metolazone), 8, 192 Zonegran (zonisamide), 9, 295 Zebeta (Bisoprolol), 7, 58 Zonisamide (Zonegran), 9, 295 Zegerid (omeprazole), 15, 212, 327 Zostavax (Zoster vaccine, live), Zelapar (selegiline), 9, 252 18, 295 Zemuron (rocuronium), 19, 248 Zoster Vaccine, Live (Zostavax), Zenapax (daclizumab), 18, 92 18, 295 Zerit (stavudine), 4, 6, 259 Zostrix (capsaicin), 10, 21, 65 Zestril (lisinopril), 6, 179 Zosyn (piperacillin-tazobactam), 3, 231 Zetia (ezetimibe), 8, 130 Zovia, 320 Ziagen (abacavir), 25 Zovirax (acyclovir), 6, 10, 29 Ziconotide (Prialt), 22, 293 Zyban (bupropion), 62 Zidovudine (Retrovir), 6, 293 Zyflo (zileuton), 23, 293 Zidovudine and Lamivudine (Combivir), Zyloprim (allopurinol), 19, 33 6, 293 Zyprexa/Zyprexa Zydis (olanzapine), Zileuton (Zyflo), 23, 293 10, 211 Zinacef [parenteral] (cefuroxime), 2, 73 Zyrtec/Zyrtec D (Cetirizine), 1, 75 Zincfrin (phenylephrine, ophthalmic), 228 Zyvox (linezolid), 3, 178, 329